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. 2023 Mar 18;48(6):2167–2195. doi: 10.1007/s00261-023-03877-2

Fig. 27.

Fig. 27

A 54-year-old female patient with metastatic non-small cell lung cancer who had been placed on immune checkpoint inhibitor (pembrolizumab) treatment. The patient acutely presented with abdominal pain and hypotension, suggesting an adrenal crisis. Adrenal insufficiency was confirmed on biochemical evaluation. Contrast-enhanced abdominal CT showed bilaterally enlarged and non-enhancing adrenal glands (arrowheads) with surrounding fat stranding. Clinical presentation and imaging findings were found to be suggestive of pembrolizumab-induced adrenalitis. The patient clinically responded well to steroid treatment. However, the patient expired due to widespread metastatic disease