NIVOLUMAB-INDUCED ISOLATED ADRENAL INSUFFICIENCY: A CASE REPORT

ABSTRACT Objective: Novel autoimmune therapies such as nivolumab, an antibody that blocks the programmed death-1 receptor (PD-1), have revolutionized management of patients with cancer. Autoimmune therapies, however, can be associated with immune-related adverse effects. Cases of pituitary and thyroid dysfunction have been previously reported. We describe a case of isolated adrenocorticotropic hormone (ACTH) deficiency associated with the immune checkpoint inhibitor nivolumab in a patient with non-small cell adenocarcinoma. Methods: The clinical presentation, laboratory data, and imaging studies for the acute episode of adrenal insufficiency are described, as well as literature review. Results: An 84-year-old male with stage IV non-small cell lung cancer (NSCLC) was hospitalized for hypotension, malaise, and confusion while undergoing chemotherapy with nivolumab. Endocrine evaluation showed a morning serum cortisol level of 1.1 μg/dL (reference range, 5 to 25 μg/dL), with an ACTH level of 9 pg/mL (referen...