Endocrine Abstracts

Introduction: Immune-checkpoint inhibitors are used in patients with advanced cancers. They are associated with a wide array of side effects known as immune-related adverse events (irAEs). These can affect skin, gastrointestinal tract, multiple endocrine glands, liver and other systems. We report a 69-year-old male with a past medical history of Chronic Obstructive Pulmonary Disease and Lung cancer who was referred by the oncology team with a clinical and biochemical picture of thyrotoxicosis (TSH < 0.5, T4 38). His symptoms started 3 weeks following the second cycle of immunotherapy in the form of palpitation, tiredness, loss of weight and hand tremors. His thyroid function spontaneously recovered but he was having ongoing tiredness and feeling unwell and dizzy when reviewed in clinic, hence, further blood tests including random cortisol were arranged and the result of cortisol was 27, subsequently, a short Synacthen test was performed and the result as follow; baseline cortisol was 106 and after 30 minutes it was 336 . Rest of pituitary hormones were unremarkable. He started him on steroids replacement and planned to repeat the short Synacthen test in 3 months. The patient’s symptoms did improve significantly following the steroids use.

Learning points:: 1. Immunotherapy induced adrenal insufficiency is rare and needs a high index of suspicion to diagnose. 2. When reviewing a patient following immunotherapy, It is important to think of other autoimmune endocrine problems when the patient has one especially if the patient’s symptoms have not improved with treatment.