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Adrenal crisis — RCPSC IM MCQ

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HardEndocrinologyAdrenal crisisRCPSC IM

A 58-year-old woman treated with pembrolizumab for melanoma presents with weakness, abdominal pain and confusion. Blood pressure is 84/50 mm Hg, sodium is 121 mmol/L, potassium is 5.8 mmol/L, glucose is 3.2 mmol/L, cortisol is very low and ACTH is elevated. TSH is mildly high. What is the most likely diagnosis?

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Correct answer: D — Primary adrenal insufficiency from immune checkpoint inhibitor adrenalitis

Shock, hyponatremia, hyperkalemia, hypoglycemia, low cortisol and high ACTH indicate primary adrenal insufficiency. Immune checkpoint inhibitors can cause adrenalitis and other endocrinopathies.

Reference: Endocrine Society adrenal insufficiency guidance; Canadian oncology toxicity practice