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In reviewing the patients medical history, we found that the patient had an episode of hyponatremia with impaired consciousness 5 months prior to admission, when the serum cortisol (8:00 a.m.) level was 117 nmol/L (reference range: 166507 nmol/L), and the corresponding ACTH level was 14.3 pg/ml pg/mL (reference range: 7.2-63.3 pg/mL), which suggested that the patient already had adrenocortical insufficiency at that time, and what we could not confirm was whether the patients impaired consciousness was a neurologic manifestation of irAEs or due to hyponatremia

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