A 58-year-old female patient with recurrent left adrenal cortical carcinoma following surgery developed severe nausea, vomiting, anorexia, and hypovolemic shock, accompanied by profound hyponatremia, approximately 2 weeks after receiving pembrolizumab immunotherapy. She was diagnosed with an acute adrenal crisis. The patient had a prior history of mitotane therapy and radiotherapy. It was believed that the adrenal crisis was triggered by pembrolizumab-induced immune-mediated adrenalitis, compounded by cumulative damage to adrenal function from both the treatment and the tumor. After aggressive management, including anti-shock treatment, high-dose glucocorticoid replacement, and symptomatic supportive care, the patient's condition improved. At the 1-month follow-up after discharge, the patient had fully recovered, with normalized hormone levels and no evidence of tumor progression. This case highlights the potential for immune checkpoint inhibitor therapy to induce life-threatening adrenal crises in patients with pre-existing adrenal insufficiency. Clinicians must remain highly vigilant, performing early hormone level screening, promptly initiating hormone replacement therapy, and ensuring multidisciplinary team (MDT) collaboration to improve patient outcomes.
Xu et al. (Fri,) studied this question.