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Updated: Jul 5, 2026
10:52
Preparation of Mouse Pituitary Immunogen for the Induction of Experimental Autoimmune Hypophysitis
Published on: December 17, 2010
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Exploring a New Entity of Single-Agent Pembrolizumab-Associated Hypophysitis
Eric Balti1, Sarah Verhaeghe1, Vibeke Kruse2
1Department of Endocrinology and Diabetes, VITAZ Hospital, Sint-Niklaas, BEL.
Cureus
|September 21, 2022
Summary
Pembrolizumab, an anti-PD1 inhibitor, can cause hypophysitis, or pituitary inflammation. This case highlights an early-onset, severe presentation of pembrolizumab-associated hypophysitis, differing from typical presentations.
Area of Science:
- Endocrinology and Oncology
- Immunotherapy-related adverse events
- Pituitary gland disorders
Background:
- Hypophysitis is pituitary inflammation, occurring primarily or secondarily to other conditions.
- Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors are known to cause hypophysitis (10-15% of cases).
- Anti-program death 1 (anti-PD1) inhibitors represent a distinct category associated with hypophysitis.
Observation:
- A 55-year-old melanoma patient developed hypophysitis symptoms (headache, nausea, fatigue) 3.5 months after starting pembrolizumab.
- Clinical presentation included secondary adrenal failure, thyrotropic insufficiency, and defective gonadotrophin secretion.
- Imaging revealed an enlarged pituitary gland with homogeneous enhancement of the gland and pituitary stalk.
Findings:
- A systematic review identified 20 patients with single-agent pembrolizumab-associated hypophysitis, with a median onset of 6 months.
- The most common hormonal defect was isolated adrenocorticotropic hormone (ACTH) deficiency.
- This case presented with early onset, panhypopituitarism, and increased pituitary mass, distinguishing it from typical presentations.
Implications:
- Early recognition and management of pembrolizumab-associated hypophysitis are crucial for patient outcomes.
- Hormonal supplementation and interruption of anti-PD1 therapy led to clinical, biological, and radiological improvement.
- Further investigation is warranted to determine if this severe presentation represents a distinct clinical entity.
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