Immune Checkpoint Inhibitor (Pembrolizumab)- and Tyrosine Kinase Inhibitor (Axitinib)-induced Hypothyroidism, Hypogonadism, Adrenal Insufficiency, and Dysglycemia in a Patient with Renal Cell Carcinoma

Abstract

ABSTRACT Immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have been successfully used to treat various types of cancer, although they have different side effect profiles. Hypothyroidism is a common endocrine side effect of both drugs, while hypofunction of other endocrine glands is less frequent. We are reporting a case of a patient with renal cell carcinoma who developed primary hypothyroidism after starting treatment with ICI (pembrolizumab) and TKI (axitinib). The patient’s symptoms partially improved after levothyroxine initiation. Subsequent screening of other endocrine glands revealed hypogonadism, adrenal insufficiency, and dysglycemia. The addition of corticosteroids and testosterone led to a dramatic improvement in the patient’s condition.