Adrenal Insufficiency Induced by Tislelizumab in a Patient with Advanced Esophageal Squamous Cell Carcinoma: Case Report

Abstract The recently updated guidelines from the National Comprehensive Cancer Network recommend the combination of tislelizumab and chemotherapy as a standard first-line treatment for patients with advanced esophageal squamous cell carcinoma(ESCC).However, concerns regarding the safety profile of tislelizumab have persisted.We report a case of a 71-year-old patient with advanced ESCC who developed adrenal insufficiency following tislelizumab administration. Biochemical evaluation revealed isolated adrenocorticotropic hormone༈ACTH༉deficiency, consistent with secondary adrenal insufficiency induced by tislelizumab.Nonetheless, patients with adrenal insufficiency receiving glucocorticoid therapy may require dose adjustment during physiologically stressful situations, such as infections, surgical procedures, trauma, or psychological stress, to adequately meet increased physiological demands. Clinicians should maintain a high index of suspicion for adrenal crisis, particularly in the presence of hypotension and severe hyponatremia, and remain vigilant for rare but potentially life-threatening immune-related adverse events associated with tislelizumab therapy.