Related Experiment Video
Updated: Jun 25, 2025
10:52
Preparation of Mouse Pituitary Immunogen for the Induction of Experimental Autoimmune Hypophysitis
Published on: December 17, 2010
14.6K
Immune checkpoint inhibitor-induced hypophysitis with transient ACTH-dependent hypercortisolism.
Fatima Abdullah AlRubaish1, Nisha Gupta2, Meng Zhu Shi3
1Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia fatima.alrubaish@mail.mcgill.ca.
BMJ Case Reports
|May 21, 2024
Summary
Immune checkpoint inhibitors can cause transient ACTH-dependent hypercortisolism, leading to secondary adrenal insufficiency. Vigilant monitoring is crucial for timely hormone replacement in patients receiving immunotherapy.
Area of Science:
- Endocrinology
- Oncology
- Immunology
Background:
- Combined immune checkpoint inhibitors (nivolumab-ipilimumab) are used for metastatic melanoma.
- Hypophysitis is a known side effect of immunotherapy, potentially affecting pituitary hormone production.
Observation:
- A patient developed refractory hypokalemia and was diagnosed with ACTH-dependent hypercortisolism 11 weeks after starting immunotherapy.
- Further investigations revealed central hypothyroidism and hypogonadotropic hypogonadism.
- Imaging showed normal adrenal glands and pituitary.
Findings:
- The patient experienced transient central hypercortisolism, indicated by rising cortisol and ACTH levels.
- Cortisol and ACTH levels subsequently decreased, leading to secondary adrenal insufficiency.
- Hormone replacement therapy with levothyroxine and hydrocortisone was initiated.
Implications:
- This case highlights immunotherapy-related hypophysitis with a distinct transient hypercortisolism phase.
- Early recognition of hypercortisolism and its rapid progression to adrenal insufficiency is vital.
- Vigilant laboratory monitoring and timely hormonal replacement are essential to prevent complications in patients on immunotherapy.
Related Concept Videos
01:37Hypothalamic-Pituitary Axis
59.9K
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
59.9K
01:27Adrenal Gland Disorders
1.5K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
1.5K
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
115
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
115
01:15Hypoglycemia and Glucagon
256
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
256
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
236
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
236
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
158
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
158