skip to main content

irAEs — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

After nivolumab-ipilimumab, a patient develops vomiting, postural hypotension, sodium 126 mmol/L, potassium 6.0 mmol/L and 09:00 cortisol 38 nmol/L. ACTH and renin are high and aldosterone is low. What is the most likely immune toxicity?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Immune-mediated primary adrenal insufficiency from adrenalitis

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

C is correct. Very low cortisol with high ACTH, hyperkalaemia, high renin and low aldosterone localises failure to the adrenal cortex and supports immune-mediated primary adrenalitis. Hypophysitis causes secondary adrenal insufficiency with low or inappropriately normal ACTH and usually preserves mineralocorticoid function, so marked hyperkalaemia is less typical. Hepatitis, diabetes and thyroiditis do not explain this biochemical axis. If adrenal crisis is suspected, take cortisol and ACTH if this causes no delay, then give immediate intravenous hydrocortisone and isotonic fluid; treatment must not wait for imaging or stimulation testing.

Reference: Society for Endocrinology emergency guidance on acute adrenal insufficiency: https://pmc.ncbi.nlm.nih.gov/articles/PMC5314805/