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Immunotherapy-Associated Hypophysitis under Anti-PD1: Two Case Reports
Xinyu Shen1, Minglan Yang1, Hua Xu1
1Department of Endocrinology and Metabolic Diseases, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Endocrine, Metabolic & Immune Disorders Drug Targets
|December 12, 2022
Summary
Immunotherapy can cause hypophysitis, a rare but serious condition. Regular endocrine monitoring is crucial for patients undergoing cancer immunotherapy to manage this adverse event effectively.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Immunotherapy, particularly with immune checkpoint inhibitors like PD-1 antagonists, can lead to hypophysitis, a rare but potentially severe adverse event.
- Hypophysitis, inflammation of the pituitary gland, can result in hormonal deficiencies and significant clinical sequelae if not promptly managed.
Observation:
- Two cases of immunotherapy-associated hypophysitis are presented: a 66-year-old man with non-small cell lung cancer treated with sintilimab and a 58-year-old patient with gastric cancer treated with carrelizumab.
- Both patients experienced hormonal deficiencies (adrenal insufficiency) secondary to hypophysitis, necessitating hormone replacement therapy.
Findings:
- Diagnosis involved assessing hyponatremia, low adrenocorticotropin and cortisol levels, and pituitary inflammation.
- Treatment included physiological glucocorticoid replacement and continued immunotherapy, alongside hormone replacement therapy.
Implications:
- Patients receiving cancer immunotherapy require regular endocrine-related follow-up to detect and manage hypophysitis.
- Early detection and management of immunotherapy-associated hypophysitis are essential to prevent potentially fatal complications and allow for continued cancer treatment.
