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Related Experiment Videos

Hélène Vinolas1, Marc Lombès2, Antoine Tabarin3

  • 1Service d'endocrinologie et diabétologie, CHU Henri-Mondor, 94010 Créteil, France.

Annales D'Endocrinologie
|October 14, 2019
PubMed
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EBioMedicine·2026

Immunotherapy and opioid use can cause secondary adrenal insufficiency (SAI). Monitoring is crucial as SAI can be transient, with new treatments improving patient outcomes.

Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • Secondary adrenal insufficiency (SAI) is increasingly linked to novel treatments like immunotherapy and widespread opioid use.
  • Immunotherapy, particularly combined CTLA4 and PD1 blockade, presents a higher risk of SAI compared to single-agent therapies.
  • Opioid-related SAI prevalence is estimated between 5-20%, with daily morphine-equivalent dose as a key risk factor.

Purpose of the Study:

  • To review the emerging causes of secondary adrenal insufficiency (SAI).
  • To discuss the prevalence, risk factors, and diagnostic approaches for SAI induced by immunotherapy and opioids.
  • To explore current and novel therapeutic strategies for managing SAI.

Main Methods:

  • Literature review of studies on immunotherapy- and opioid-induced SAI.
Keywords:
ImmunotherapyImmunothérapieInsuffisance corticotropeOpioidsOpioïdesPompes sous cutanée à hydrocortisoneSecondary adrenocortical insufficiencySubcutaneous hydrocortisone pumpsSynacthen testTest au Synacthène

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  • Analysis of diagnostic criteria, including morning cortisol levels and Synacthen® testing.
  • Evaluation of new hydrocortisone formulations and continuous infusion systems.

    • Main Results:

    • Immunotherapy-associated SAI occurs in 1-10% of patients, with higher rates in combined therapies.
    • Isolated SAI cases have been reported with PD1 inhibitors, and SAI can be transient.
    • Opioid-related SAI prevalence is significant, influenced by dosage, necessitating careful diagnosis.

    Conclusions:

    • Secondary adrenal insufficiency is an important consideration in patients receiving immunotherapy or long-term opioid analgesics.
    • Accurate diagnosis and monitoring are essential, with potential reevaluation of current diagnostic cut-offs.
    • Advanced hydrocortisone replacement therapies offer improved management for patients with SAI.