[in Japanese]

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　A-60-year-old man presented with right cervical lymphadenopathy. Histological analysis of the lymph node demonstrated metastasis of squamous-cell-carcinoma. Chest computed tomography (CT) showed a pulmonary tumor lesion at the right upper lobe (S1). Thus, diagnosis of lung squamous cell carcinoma (cT2aN3M1c, stage Ⅳ B (LYM, OSS)) was determined. 　Immunostaining of the tumor revealed PD-L1 of >50% cancer cells was positive. Pembrolizumab (200 mg/body every 3 weeks) was introduced as first-line therapy. After 5 times of administration, he presented with physical weariness. Laboratory data of peripheral blood showed an elevated proportion of eosinophils and undetectable levels of both cortisol and adrenocorticotropic hormone (ACTH). Basal concentrations of other endocrine hormones were within normal range. High-dose ACTH stimulation test revealed a poor response of cortisol secretion, indicative of secondary adrenal cortical insufficiency. No metastatic and/or primary lesions of pituitary gland and bilateral adrenal glands were found upon examinations of head magnetic resonance imaging and abdominal CT. Finally, diagnosis of isolated ACTH deficiency due to pembro-lizumab was confirmed.

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