Endocrine Abstracts

Introduction: Immune checkpoint inhibitors (ICIs) have gained popularity as a standard cancer treatment in recent years. IrAEs, or immune-related adverse events, are specific immunological side effects that are linked to ICIs. Thyroid dysfunction is a prevalent irAE, but the cause, severity, and clinical appearance might vary. The most frequent thyroid irAEs brought on by ICIs are destructive thyroiditis and hypothyroidism, whereas immune-related adrenal insufficiency is uncommon. We describe a case of hypothyroidism and transient adrenal insufficiency after nivolumab treatment in a renal cell carcinoma woman.

Case Presentation: A 54-year-old woman developed overt autoimmune hypothyroidism 5 months after she had started nivolumab (anti-PD-1) therapy for a metastatic renal cell carcinoma. The only complaint she had was extreme fatigue. Her TPO and Tg autoantibodies were positive, TSH and ACTH were high, and Ft4 and cortisol levels were low. For the evaluation of other pituitary hormones were assessed: FSH, LH, and prolactin. The patient was given hydrocortisone right away, followed by L-thyroxine and selenium a week later.

Conclusions: Autoimmune hypothyroidism and adrenal insufficiency can be induced by anti-PD-1 treatment. An elevated level of clinical suspicion is required for the diagnosis of endocrinopathies due to an upward trend in endocrine disorders among cancer patients receiving immunotherapy. Early management of ICIs-induced endocrinopathies improves the quality of cancer care.