近年来，由于其在各种恶性肿瘤中改善了预后，检查点抑制剂获得了增加的关注。自2019年以来，一种抗编程细胞死亡蛋白（PD-1）单克隆抗体——Pembrolizumab已成为Ⅱ期非小细胞肺癌的一线化疗药物。尽管与nivolumab相比更常见，但几种与Pembrolizumab相关的免疫相关不良反应，尤其是内分泌疾病，已被联系在一起。我们报道了一个59岁男性的病例，他有未特指的肺癌病史，出现了严重的低钠血症，后来被归因于Pembrolizumab引起的继发肾上腺功能不全和伴随的主性甲状腺功能减退症。由于免疫检查点抑制剂如Pembrolizumab在患者中引起的肾上腺功能不全的症状不具特异性，确诊变得具有挑战性，因此必须排除其他引起低钠血症的原因。免疫疗法已被认为会引起甲状腺免疫相关不良事件，但在诊断甲状腺功能减退症时，并非总是存在抗甲状腺抗体。虽然有一些报道的Pembrolizumab引起的肾上腺功能不全病例，但免疫疗法与内分泌疾病之间的联系仍不清楚。据我们所知，尚无病例报告描述使用Pembrolizumab后出现主性甲状腺功能减退症和继发性肾上腺功能不全，尽管已有该类病例涉及axitinib。及时诊断和治疗肾上腺功能不全对于预防不良反应至关重要，尤其是对于接受免疫疗法的癌症患者，正如本病例所强调的那样。

Checkpoint inhibitors have gained increased traction in recent years as they have improved prognosis in various malignancies. Pembrolizumab, an anti-programmed cell death protein (PD-1) monoclonal antibody, has become a first-line chemotherapeutic agent for stage II non-small cell lung cancer since 2019. Although much more common with nivolumab, several immune-related adverse effects, particularly endocrinopathies, have been linked with pembrolizumab. We describe a case of a 59-year-old man with a history of unspecified lung cancer who presented with severe hyponatremia later attributed to secondary adrenal insufficiency and accompanying primary hypothyroidism secondary to pembrolizumab. Diagnosing adrenal insufficiency in patients on immune checkpoint inhibitors like pembrolizumab can be challenging due to nonspecific symptoms, making it crucial to rule out other causes of hyponatremia. Immunotherapy is known to cause thyroid immune-related adverse events, and anti-thyroid antibodies may not always be present in the diagnosis of hypothyroidism. Although there are some reported cases of pembrolizumab-induced adrenal insufficiency, the link between immunotherapy and endocrine disorders remains unclear. To our knowledge, no case reports exist that describe both primary hypothyroidism and secondary adrenal insufficiency after taking pembrolizumab, although such cases have been documented with axitinib. Timely diagnosis and treatment of adrenal insufficiency is crucial to prevent adverse effects, especially in patients with cancer receiving immunotherapy, as highlighted in this case.