A Systematic Review of Ipilimumab-Induced Hypophysitis

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Ipilimumab, a CTLA-4 antibody, improves cancer outcomes but can cause immune-related adverse events (IRAEs).
• Hypophysitis is a rare but severe IRAE associated with ipilimumab treatment.
• Understanding ipilimumab-induced hypophysitis is crucial for patient management.

Purpose of the Study:

• To review clinical features, diagnosis, and treatment of ipilimumab-induced hypophysitis.
• To explore the pathophysiology of this condition.
• To present a case report illustrating ipilimumab-induced hypophysitis.

Main Methods:

• Systematic review of published ipilimumab-induced hypophysitis cases.
• Data extraction on patient demographics, treatment, and outcomes.
• Inclusion of a detailed case report of a patient with renal cell carcinoma.

Main Results:

• Review of 92 patients showed common symptoms like headache and fatigue.
• Panhypopituitarism and adrenal insufficiency were frequent endocrine issues.
• Only 15% of patients fully recovered pituitary function; most required hormone replacement.

Conclusions:

• Ipilimumab-induced hypophysitis is a significant IRAE with often irreversible endocrine deficits.
• Prompt glucocorticoid treatment is vital, but long-term hormone replacement is frequently needed.
• Further research into predictive markers and prevention is warranted due to autoimmune pathogenesis.