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Immune checkpoint inhibitors can cause immune-related adverse events like thyroiditis and hypophysitis. This case highlights a patient with concurrent immune-related hyperthyroidism and a pituitary macroadenoma, emphasizing prompt corticosteroid treatment.

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Area of Science:

  • Oncology
  • Endocrinology
  • Immunology

Background:

  • Immune checkpoint blockade is a revolutionary cancer therapy.
  • This treatment can lead to immune-related adverse events affecting various organs, including the thyroid and pituitary.
  • Differentiating these events from other conditions is crucial for effective management.

Observation:

  • A 77-year-old male with metastatic renal cell carcinoma presented with severe headache.
  • Initial evaluation revealed subclinical hyperthyroidism and pituitary gland enlargement consistent with macroadenoma.
  • Hormonal assessment indicated secondary hypothyroidism, possibly due to pituitary apoplexy.

Findings:

  • The patient was diagnosed with immune-related hyperthyroidism and a concurrent pituitary macroadenoma.
  • High-dose corticosteroid therapy was initiated for suspected immune-related hypophysitis.
  • Levothyroxine substitution was started for central hypothyroidism.

Implications:

  • This case underscores the necessity of considering non-immune-related conditions alongside immune-related adverse events in patients receiving immunotherapy.
  • Prompt corticosteroid administration is vital for managing suspected hypophysitis to prevent potentially fatal outcomes.
  • Integrated management of endocrine dysfunction and oncologic treatment is essential for patient well-being.