Arginine vasopressin deficiency following pembrolizumab-induced hypophysitis: a case report and review of the literature
- 1Department of Internal Medicine, Cantonal Hospital Grisons
- 2Department of Oncology and Hematology, Cantonal Hospital Grisons
- 3Faculty of Biomedical Sciences, Università della Svizzera Italiana
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized oncologic therapy by substantially improving survival outcomes in various malignancies. These agents—such as ipilimumab, nivolumab, pembrolizumab, atezolizumab, and durvalumab—modulate the immune system by inhibiting key checkpoint receptors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PDL-1), thereby facilitating tumor regression. However, immune modulation frequently triggers immune-related adverse events, which can affect any organ system, particularly the skin, liver, gastrointestinal tract, lung, and endocrine glands. Among the most common endocrine disorders induced by ICIs are thyroid, pituitary, adrenal, and beta-cell dysfunctions. Pituitary dysfunction is most commonly associated with combined CTLA-4 and PD-1/PDL-1 inhibitor regimens. This case report discusses a rare instance of presumed arginine vasopressin deficiency (AVP-D) secondary to pembrolizumab-monotherapy-induced hypophysitis, which was unmasked following glucocorticoid therapy. A 59-year-old male with metastatic lung adenocarcinoma treated with pembrolizumab developed gastrointestinal symptoms and was subsequently diagnosed with toxic colitis. Following the initiation of glucocorticoid therapy, he developed hypernatremia, polyuria, and polydipsia. Further evaluation suggested AVP-D, with rapid symptom resolution under desmopressin. This report underscores the complexity of endocrine disturbances associated with ICIs and the diagnostic challenges associated with glucocorticoid therapy in patients with ICI-related hypophysitis. The occurrence of arginine vasopressin deficiency in the context of pembrolizumab-induced hypophysitis is rare and not well investigated, highlighting the need for further research into the underlying mechanisms and optimal clinical management of these immune-mediated endocrine disorders.
Related
- Isolated Adrenocorticotropic Hormone Deficiency Secondary to Pembrolizumab-Induced Hypophysitis: A Case of Life-Threatening Adrenal Crisis in a Patient With Metastatic Melanoma
- Probable Hypophysitis Recognized More Than Two Years After Pembrolizumab Discontinuation
- Diagnostic challenges of masked arginine vasopressin deficiency in neurosarcoidosis complicated by sodium–glucose cotransporter 2 inhibitor use
- Ectopic rabphilin-3A expression in lung adenocarcinoma associated with paraneoplastic arginine vasopressin deficiency during anti-PD-L1 therapy: a case report.
- Acute colonic pseudo-obstruction with transient failure of oral desmopressin in adipsic arginine vasopressin deficiency.
BibTeX
@article{dold2026arginine,
title = {{Arginine vasopressin deficiency following pembrolizumab-induced hypophysitis: a case report and review of the literature}},
author = {Annina Rebecca Dold and Raphael Jeker and Michael Mark},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1976186},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1976186/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Arginine vasopressin deficiency following pembrolizumab-induced hypophysitis: a case report and review of the literature
AU - Annina Rebecca Dold
AU - Raphael Jeker
AU - Michael Mark
PY - 2026
DA - 2026/10/23
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1976186
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1976186/full
AB - Immune checkpoint inhibitors (ICIs) have revolutionized oncologic therapy by substantially improving survival outcomes in various malignancies. These agents—such as ipilimumab, nivolumab, pembrolizumab, atezolizumab, and durvalumab—modulate the immune system by inhibiting key checkpoint receptors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PDL-1), thereby facilitating tumor regression. However, immune modulation frequently triggers immune-related adverse events, which can affect any organ system, particularly the skin, liver, gastrointestinal tract, lung, and endocrine glands. Among the most common endocrine disorders induced by ICIs are thyroid, pituitary, adrenal, and beta-cell dysfunctions. Pituitary dysfunction is most commonly associated with combined CTLA-4 and PD-1/PDL-1 inhibitor regimens. This case report discusses a rare instance of presumed arginine vasopressin deficiency (AVP-D) secondary to pembrolizumab-monotherapy-induced hypophysitis, which was unmasked following glucocorticoid therapy. A 59-year-old male with metastatic lung adenocarcinoma treated with pembrolizumab developed gastrointestinal symptoms and was subsequently diagnosed with toxic colitis. Following the initiation of glucocorticoid therapy, he developed hypernatremia, polyuria, and polydipsia. Further evaluation suggested AVP-D, with rapid symptom resolution under desmopressin. This report underscores the complexity of endocrine disturbances associated with ICIs and the diagnostic challenges associated with glucocorticoid therapy in patients with ICI-related hypophysitis. The occurrence of arginine vasopressin deficiency in the context of pembrolizumab-induced hypophysitis is rare and not well investigated, highlighting the need for further research into the underlying mechanisms and optimal clinical management of these immune-mediated endocrine disorders.
SN - 1664-2392
ER -