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Case Reports: Reminder of important clinical lesson
PD-1 inhibitor-induced thyroiditis and ACTH deficiency
  1. Nayab Shah1,
  2. David Prentice2 and
  3. Chandrin Jayasundera1
  1. 1 St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
  2. 2 Internal medicine, Royal Perth Hospital, Perth, Australian Capital Territory, Australia
  1. Correspondence to Dr Nayab Shah; dr.nayab.shah{at}gmail.com

Abstract

A woman in her 70s on pembrolizumab for non-small cell lung cancer experienced progressive fatigue, intractable nausea and reduced mobility since commencing her cancer treatment. After repeat admissions and prolonged inpatient stay from compounded septicaemia, a diagnosis of programmed cell death 1 (PD-1) inhibitor-induced hypophysitis was confirmed, with remarkable improvement on commencement of cortisol replacement.

While this side effect is known to oncologists, the non-specific symptoms and a lack of familiarity with PD-1 inhibitor and programmed cell death ligand 1 inhibitor therapies in other medical fields can result in diagnostic delays if not actively searching for hypophysitis.

Intractable nausea, vomiting and weight loss, even in the absence of hyponatraemia or hypoglycaemia, should trigger physicians to consider hypophysitis.

  • Pituitary disorders
  • Chemotherapy
  • Lung cancer (oncology)
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2022-254034

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    Footnotes

    • Contributors All authors (DP, NS and CJ) were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content, responsible for drafting of the text and diagrams and revisions and gave the final approval of the manuscript . NS and CJ were directly involved in patient care. DP is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.