{"title":"Adrenal crisis due to pembrolizumab-induced hypophysitis in a patient with triple-negative breast cancer.","authors":"Sobrina S Mohammed, Sallam Alrosan, Reda Asad","doi":"10.1530/EO-25-0046","DOIUrl":null,"url":null,"abstract":"<p><p>We report a case of a 43-year-old woman with stage IIB triple-negative breast cancer (TNBC) on neoadjuvant pembrolizumab presenting in adrenal crisis. Biochemical evaluation revealed isolated adrenocorticotropic hormone (ACTH) deficiency, and MRI demonstrated a partial empty sella; findings consistent with pembrolizumab-induced hypophysitis. Glucocorticoid replacement therapy led to symptom resolution. Pembrolizumab-induced hypophysitis is rare (incidence ∼0.98%), often associated with isolated ACTH deficiency, making diagnosis challenging due to nonspecific symptoms and frequently unremarkable pituitary imaging. As ICI use expands, clinician awareness of immune-related adverse effects (irAEs) is essential to prevent life-threatening complications and improve outcomes.</p>","PeriodicalId":72907,"journal":{"name":"Endocrine oncology (Bristol, England)","volume":"5 1","pages":"e250046"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203771/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine oncology (Bristol, England)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1530/EO-25-0046","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
We report a case of a 43-year-old woman with stage IIB triple-negative breast cancer (TNBC) on neoadjuvant pembrolizumab presenting in adrenal crisis. Biochemical evaluation revealed isolated adrenocorticotropic hormone (ACTH) deficiency, and MRI demonstrated a partial empty sella; findings consistent with pembrolizumab-induced hypophysitis. Glucocorticoid replacement therapy led to symptom resolution. Pembrolizumab-induced hypophysitis is rare (incidence ∼0.98%), often associated with isolated ACTH deficiency, making diagnosis challenging due to nonspecific symptoms and frequently unremarkable pituitary imaging. As ICI use expands, clinician awareness of immune-related adverse effects (irAEs) is essential to prevent life-threatening complications and improve outcomes.
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