DIABETES AND HYPOPITUITARISM AS IMMUNE-RELATED ENDOCRINOPATHIES ASSOCIATED WITH PEMBROLIZUMAB THERAPY IN A PATIENT WITH ADVANCED RENAL CELL CARCINOMA

Abstract

CASE
We report a 59-year-old Malaysian-Chinese male with bilateral renal cell carcinoma with liver metastases who developed diabetes and hypopituitarism after approximately ten months on pembrolizumab. He presented with a one-week history of lethargy, polyuria, polydipsia, and nocturia. He was admitted to a private hospital as a case of diabetic ketoacidosis and was discharged with basal-bolus insulin. Three days after discharge, he was admitted to the oncology ward for uncontrolled diabetes without ketosis. Blood tests showed high serum glucose, low morning cortisol 11 nmol/L, low ACTH and low testosterone with inappropriately normal FSH and LH. He was diagnosed with diabetes, secondary adrenal insufficiency and hypogonadotropic hypogonadism. His condition improved after administration of basal-bolus insulin and hydrocortisone. He experienced spontaneous recovery of the gonadal axis after three months.