Concomitant Immune Checkpoint Inhibitors Induced Central and Primary Adrenal Insufficiency : A Diagnostic Challenge

Article Article scientifique Rapport de cas Concomitant Immune Checkpoint Inhibitors Induced Central and Primary Adrenal Insufficiency : A Diagnostic Challenge eng 2025-08-22 2025-10 author Nasce Alberto 0009-0005-9736-1252 Department of Endocrinology and Diabetology, Hôpitaux Universitaires de Genève, Geneva 1205, Switzerland. 444443 author Leboulleux Sophie Department of Endocrinology and Diabetology, Hôpitaux Universitaires de Genève, Geneva 1205, Switzerland. 984598 Département de médecine (DEMED) author Chiriac Simina Department of Radiology and Medical Informatics, Hôpitaux Universitaires de Genève, Geneva 1205, Switzerland. 405944 author Tsantoulis Petros 0000-0003-3613-6682 Department of Medical Oncology, Hôpitaux Universitaires de Genève, Geneva 1205, Switzerland. 861166 Département de médecine (DEMED) author Mavromati Maria Department of Endocrinology and Diabetology, Hôpitaux Universitaires de Genève, Geneva 1205, Switzerland. 810886 luaf194 10.1210/jcemcr/luaf194 40860571 2755-1520 PMC12371529 https://academic.oup.com/jcemcr/article/doi/10.1210/jcemcr/luaf194/8239701 Immune checkpoint inhibitors (ICI) have several endocrine toxicities. Dual sequential pituitary and adrenal toxicities are rare and difficult to diagnose. This case report describes a 63-year-old man with metastatic clear cell renal carcinoma treated with combined nivolumab and ipilimumab. After 3 cycles, he presented with severe headaches. The imaging studies revealed pituitary enlargement consistent with hypophysitis. Hormonal assessment confirmed panhypopituitarism, leading to high-dose hydrocortisone replacement. Four months later, a routine computed tomography scan showed significant bilateral adrenal enlargement. Later symptoms of fatigue and low blood pressure, combined with high potassium, suppressed aldosterone, and high renin, confirmed the diagnosis of immune checkpoint inhibitor-associated adrenalitis, while ACTH remained low due to pituitary function impairment. Fludrocortisone was added, resulting in clinical improvement, and a control scan showed reduced adrenal size compared to previous imaging. This case emphasizes the importance of radiological and laboratory assessments in diagnosing concomitant central and peripheral adrenal insufficiency during ICI therapy. Adrenalitis Hypophysitis Immune checkpoint inhibitors Dewey 616.0757 Dewey 616 56 Département de médecine 221 62 Département de radiologie et informatique médicale 227 false 1263 MASLD/MASH et résistance à l'insuline 997 JCEM case reports 3 10 42119d3d-2dca-4ce3-a883-bca8fca94dd0 Article (Published version) Public luaf194.pdf 629726 application/pdf CC BY-4.0 9e561e81862305cbbbd1f7313ed51bb3b29f28b5b03a7de78037d16aa04066d4 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Concomitant Immune Checkpoint Inhibitors Induced Central and Primary Adrenal Insufficiency : A Diagnostic Challenge	JCEM case reports			2025	12	937

Archive ouverte UNIGE

Nasce, Alberto