Isolated Adrenocorticotropic Hormone Deficiency Caused by Camrelizumab in a Patient with Lung Sarcoma: A Case Report and Literature Review

Immune checkpoint inhibitors (ICIs) significantly increase survival in some malignant tumors, but they also lead to a variety of immune-related adverse events that affect multiple organs, including the liver, lung and endocrine system. Isolated adrenocorticotropic hormone deficiency (IAD), a rare pituitary disorder, may manifest with non-specific symptoms. Clinicians may not be aware of this unusual side effect. We hereby describe a 70-year-old male patient who had lung sarcoma and was treated with camrelizumab. He developed immune-related pneumonia and hepatitis, subsequent late-onset IAD with severe hyponatremia. His symptoms alleviated after glucocorticoid therapy. So regularly monitoring endocrine functions should be beneficial for cancer patients treated by camrelizumab. Clinicians should consider IAD induced by ICIs when hyponatremia occurs in these patients. Timely hydrocortisone replacement therapy can avoid serious, life-threatening adrenal crisis. Keywords: Isolated adrenocorticotropic hormone deficiency; Camrelizumab; Lung sarcoma; Hyponatremia Abbreviations: ACTH: Adrenocorticotropic Hormone; TSH: Thyroid-stimulating Hormone; TPOAb: Antithyroperoxidase Antibody; TgAb: Anti-thyroglobulin Antibody; FSH: Follicle Stimulating Hormone; LH: Luteinizing Hormone; GH: Growth Hormone; IGF-1: Insulin-like Growth Factor 1