Immune Checkpoint Inhibitor Therapy Induced Hypophysitis; A Tertiary Care Centre Experience; Highlighting Detection, Treatment Outcomes and Long Term Endocrinopathies and Recovery - PubMed
8 hours ago
- #immune checkpoint inhibitor therapy
- #secondary adrenal insufficiency
- #hypophysitis
- Immune checkpoint inhibitor (ICI) therapy-induced hypophysitis (ICI-Hp) is a common endocrine immune-related adverse effect requiring prompt recognition.
- Study of 22 patients showed median onset at 13 weeks after the 3rd ICI cycle, with symptoms like headache, fatigue, nausea, and hyponatremia.
- All patients developed secondary adrenal insufficiency (SAI); 41% had secondary hypothyroidism (SH), and 27% had secondary hypogonadism (SHG).
- Pituitary imaging often revealed an enlarged pituitary gland (64%) or thickened stalk (50%), with some cases of optic chiasm compression.
- Glucocorticoid treatments (e.g., IV methylprednisolone, prednisolone) led to symptom resolution in all patients, regardless of regimen, but one case of acute psychosis occurred with IV methylprednisolone.
- SAI did not recover during follow-up, while SH recovered in 33% and SHG in 67% of patients; 18% developed new-onset type 1 diabetes, including three with diabetic ketoacidosis.
- ICI-Hp is most common after the 3rd cycle of combination ICI therapy, highlighting the need for physician and patient awareness of symptoms at that stage.
- Long-term glucocorticoid replacement is typically required for permanent ACTH deficiency, emphasizing the importance of patient education.