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Immune checkpoint inhibitors (ICI) can cause hypophysitis, a rare side effect. This case highlights the importance of recognizing subtle symptoms in elderly patients receiving combination therapy for prompt diagnosis and management.

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Area of Science:

  • Endocrinology
  • Oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) enhance antitumor responses but can cause immune-related adverse events (irAEs).
  • Hypophysitis is a known irAE, particularly with CTLA-4 inhibitors.
  • Atypical presentations of irAEs can mimic other conditions, complicating diagnosis.

Purpose of the Study:

  • To report a case of hypophysitis in an elderly patient on combination ICI therapy.
  • To emphasize the importance of recognizing subtle and nonspecific symptoms of ICI-induced hypophysitis.
  • To highlight the diagnostic challenges and need for heightened awareness of adverse endocrine events.

Main Methods:

  • Case report of a 76-year-old woman receiving ICI therapy.
  • Clinical evaluation including electrolyte assessment and MRI.
  • Treatment with fluid resuscitation and corticosteroid replacement.

Main Results:

  • The patient presented with nonspecific symptoms (back pain, nausea) and severe hyponatremia.
  • Diagnosis of ICI-induced hypophysitis was confirmed.
  • Evaluation revealed electrolyte abnormalities, secondary adrenal insufficiency, and pituitary enlargement.

Conclusions:

  • ICI-induced hypophysitis can present subtly, especially in elderly patients on combination therapy.
  • Prompt recognition and management of ICI-induced hypophysitis are crucial for patient outcomes.
  • Increased awareness and monitoring protocols for adverse endocrine events are essential for safe ICI use.