Normal adrenocorticotropic hormone levels do not exclude adrenal insufficiency during immune checkpoint inhibitor therapy: evidence from clinical, steroid, and structural analyses.

ABSTRACT:

Introduction

Immune checkpoint inhibitor-induced isolated adrenocorticotropic hormone (ACTH) deficiency (ICI-IAD) represents a critical endocrine immune-related adverse event (irAE) that may become life-threatening without timely diagnosis. Most cases present with suppressed ACTH and cortisol levels; however, a subset of patients shows preserved ACTH levels despite biochemical evidence of adrenal insufficiency. The mechanism and clinical implications underlying this discordance remain poorly defined. This study aimed to investigate the pathophysiological basis and clinical significance of preserved ACTH in patients with ICI-IAD.

Methods

This study involved retrospective and prospective analysis of 49 patients diagnosed with ICI-IAD. Based on plasma ACTH levels, patients were

SUBMITTER: Ishibashi Y 

PROVIDER: S-EPMC12580128 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature