Adrenal crisis occurring after the application of immune checkpoint inhibitors in a hepatitis B - related hepatocellular carcinoma patient: case report and literature review

Yue GuoWanhua RenQiang ZhuFei Fei Li^*

• Department of Infectious Diseases, Shandong Provincial Hospital, Jinan, China

Immune checkpoint inhibitors (ICIs) have become an important part of the treatment for hepatocellular carcinoma (HCC). However, the immune - related adverse events (irAEs) induced by them have also received increasing attention. This case report describes a rare case of adrenal crisis that occurred in an HCC patient after receiving sintilimab combined with targeted therapy. The patient presented with fever, acute abdomen, blood glucose 2.79 mmol/L, blood sodium 130.9 mmol/L, ACTH <1.5 pg/mL, COR 5.16 μg/dL, and progressive hypotension occurred. As for the timely diagnosis and active rescue by the multidisciplinary team (MDT), especially the timely supplementation of glucocorticoids, the patient's changes was effectively controlled. This is the first adrenal crisis case treated in our department. The successful management of this case emphasizes the importance of recognizing endocrine crises induced by ICIs. When diagnosing and treating liver cancer patients who have received targeted combined immunotherapy, it is necessary to distinguish between septic shock and adrenal crisis to avoid misdiagnosis or missed diagnosis.