Concomitant Immune Checkpoint Inhibitors Induced Central and Primary Adrenal Insufficiency: A Diagnostic Challenge. (2025)

Immune checkpoint inhibitors (ICI) have several endocrine toxicities. Dual sequential pituitary and adrenal toxicities are rare and difficult to diagnose. This case report describes a 63-year-old man with metastatic clear cell renal carcinoma treated with combined nivolumab and ipilimumab. After 3 cycles, he presented with severe headaches. The imaging studies revealed pituitary enlargement consistent with hypophysitis. Hormonal assessment confirmed panhypopituitarism, leading to high-dose hydrocortisone replacement. Four months later, a routine computed tomography scan showed significant bilateral adrenal enlargement. Later symptoms of fatigue and low blood pressure, combined with high potassium, suppressed aldosterone, and high renin, confirmed the diagnosis of immune checkpoint inhibito