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Multigland dysfunction from immune-checkpoint inhibitors: a case of hypothyroidism, diabetes, and adrenal insufficiency.

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JCEM case reports 📖 저널 OA 100% 2023: 6/6 OA 2024: 12/12 OA 2025: 16/16 OA 2026: 17/17 OA 2023~2026 2026 Vol.4(3) p. luag024 OA
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Vengilote R, Onwudiwe O, Yousef A, Quartuccio M

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Immune-checkpoint inhibitors (ICIs) such as nivolumab and ipilimumab have improved outcomes in metastatic renal cell carcinoma (RCC) but can cause immune-related adverse events (irAEs), including pote

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APA Vengilote R, Onwudiwe O, et al. (2026). Multigland dysfunction from immune-checkpoint inhibitors: a case of hypothyroidism, diabetes, and adrenal insufficiency.. JCEM case reports, 4(3), luag024. https://doi.org/10.1210/jcemcr/luag024
MLA Vengilote R, et al.. "Multigland dysfunction from immune-checkpoint inhibitors: a case of hypothyroidism, diabetes, and adrenal insufficiency.." JCEM case reports, vol. 4, no. 3, 2026, pp. luag024.
PMID 41737644 ↗

Abstract

Immune-checkpoint inhibitors (ICIs) such as nivolumab and ipilimumab have improved outcomes in metastatic renal cell carcinoma (RCC) but can cause immune-related adverse events (irAEs), including potentially irreversible endocrine toxicities with long-term treatment implications. We present a 62-year-old man with metastatic clear-cell RCC who developed 3 distinct endocrine irAEs during ICI therapy: thyroiditis evolving into hypothyroidism, insulin-dependent diabetes mellitus with diabetic ketoacidosis, and secondary adrenal insufficiency (AI), necessitating ICI discontinuation. Additionally, he experienced immune-mediated inflammatory arthritis. His course required thyroid hormone replacement, insulin therapy, and hydrocortisone for AI. This case underscores the potential for sequential, multiglandular endocrine toxicities from ICIs, a phenomenon infrequently reported in the literature. Clinicians should remain vigilant for delayed or evolving presentations, even in the absence of autoantibodies or radiographic abnormalities. Early recognition, multidisciplinary management, and long-term follow-up are critical for ICI-associated endocrinopathies.

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