Progression of Hypopituitarism and Hypothyroidism after Treatment with Pembrolizumab in a Patient with Adrenal Metastasis from Non-small-cell Lung Cancer

Intern Med. 2019 Dec 15;58(24):3557-3562. doi: 10.2169/internalmedicine.3008-19. Epub 2019 Aug 28.


Pembrolizumab, or anti-programmed death receptor 1 antibody, is an immune checkpoint inhibitor that can cause immune-related adverse events. We herein report for the first time the progression of hypopituitarism and hypothyroidism after treatment with pembrolizumab in a patient with adrenal metastasis of non-small-cell lung cancer. Severe primary hypothyroidism occurred three weeks after the first administration of pembrolizumab. Four months after the discontinuation of pembrolizumab, isolated adrenocorticotropic hormone (ACTH) deficiency was noted. Corticotropin-releasing hormone and rapid ACTH tests performed repeatedly showed that the patient's pituitary and adrenal function had been gradually deteriorating. It is important to diagnose adrenal insufficiency without delay in order to prevent adrenal crisis.

Keywords: hypopituitarism; hypothyroidism; immune-related adverse events; pembrolizumab.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Gland Neoplasms / drug therapy*
  • Adrenal Gland Neoplasms / secondary
  • Adrenal Insufficiency / chemically induced
  • Adrenocorticotropic Hormone / deficiency
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects*
  • Antineoplastic Agents, Immunological / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / secondary
  • Corticotropin-Releasing Hormone / analysis
  • Disease Progression
  • Humans
  • Hypopituitarism / chemically induced*
  • Hypothyroidism / chemically induced*
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / pathology
  • Male


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • Adrenocorticotropic Hormone
  • Corticotropin-Releasing Hormone
  • pembrolizumab

Supplementary concepts

  • Adrenocorticotropic hormone deficiency