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Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management
Anupam Kotwal1, Jordan E Perlman2, Whitney S Goldner1
1Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
JCO Oncology Practice
|April 6, 2023
Summary
Immune checkpoint inhibitors (ICPis) can cause endocrine immune-related adverse events (irAEs). Prompt hormone testing and replacement therapy are crucial for managing these potentially life-threatening toxicities in cancer patients.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Immune checkpoint inhibitors (ICPis) are effective cancer treatments.
- ICPis can cause immune-related adverse events (irAEs), particularly endocrine dysfunctions.
- Endocrine irAEs present nonspecific symptoms, complicating diagnosis and management.
Purpose of the Study:
- To review the evaluation and management of endocrine irAEs.
- To highlight challenges and provide guidance for clinicians.
- To reference guidelines from oncologic societies.
Main Methods:
- Synthesis of existing studies on endocrine irAEs.
- Focus on clinical features, diagnosis, and management strategies.
- Inclusion of relevant oncologic society guidelines.
Main Results:
- Endocrine irAEs are common and challenging to manage.
- Accurate hormone testing is essential for case-finding.
- Hormone replacement is the primary management strategy.
- Adrenal insufficiency and diabetes require prompt recognition and treatment.
Conclusions:
- Management of endocrine irAEs requires a unique approach focusing on hormone replacement.
- Timely diagnosis and treatment of adrenal insufficiency and diabetes are critical.
- Clinicians must be vigilant for nonspecific symptoms of endocrine dysfunction in patients on ICPis.
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