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Pituitary enlargement following ipilimumab without long term endocrine dysfunction
Edson Nogueira1, Arjun Menon1, Anastasia Dede1
1Department of Endocrinology, Chelsea and Westminster NHS Foundation Trust, London, UK.
Current Problems in Cancer
|February 24, 2021
Summary
Ipilimumab can cause hypophysitis with pituitary enlargement. However, some patients may not experience long-term hormone deficiencies, highlighting the need for endocrine assessment.
Area of Science:
- Immunotherapy
- Endocrinology
- Oncology
Background:
- Ipilimumab is a monoclonal antibody targeting CTLA-4, used for melanoma and renal cell cancer.
- Hypophysitis, characterized by pituitary enlargement and hypopituitarism (often ACTH deficiency), is a known adverse event of ipilimumab.
- ACTH deficiency resulting from ipilimumab-induced hypophysitis is typically permanent.
Observation:
- This study presents 3 cases of patients who developed pituitary enlargement consistent with hypophysitis after ipilimumab treatment.
- Crucially, these patients did not exhibit any long-term pituitary hormone deficiencies.
Findings:
- Pituitary enlargement in the context of ipilimumab treatment does not always lead to persistent hypopituitarism.
- The observed cases suggest a potential for recovery or absence of severe endocrine dysfunction despite imaging findings.
Implications:
- Comprehensive endocrine assessment is essential for patients experiencing pituitary enlargement during ipilimumab therapy, regardless of imaging findings.
- These findings may influence monitoring protocols and patient management strategies for ipilimumab-related hypophysitis.
- Further research is warranted to understand the mechanisms behind reversible or absent hormone deficiencies in ipilimumab-induced hypophysitis.
