2020
DOI: 10.3389/fonc.2020.582394
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Case Report: Ipilimumab-Induced Panhypophysitis: An Infrequent Occurrence and Literature Review

Abstract: BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immune system, can improve survival of patients affected by several malignancies, but may trigger a broad spectrum of adverse events, including autoimmune hypophysitis. ICI-related hypophysitis mainly manifests with anterior hypopituitarism, while the simultaneous involvement of both anterior and posterior pituitary (i.e., panhypophysitis) has rarely been described.Case PresentationIn June 2015, a 64-year-old man affect… Show more

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Cited by 18 publications
(34 citation statements)
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“…irAEs are inherently related to immunological mechanisms of action of ICIs and may potentially affect all organs, with the skin, gastrointestinal apparatus, and endocrine systems being mainly affected [36]. Hypophysitis, thyroid dysfunction, type 1 diabetes mellitus (T1DM), central diabetes insipidus, and PAI are ICI-induced endocrine irAEs [37,38]. Causative and risk factors eliciting the endocrine system's involvement (and other organs) in ICI-related toxicity are currently unknown.…”
Section: Ici-induced Adrenal Insufficiencymentioning
confidence: 99%
“…irAEs are inherently related to immunological mechanisms of action of ICIs and may potentially affect all organs, with the skin, gastrointestinal apparatus, and endocrine systems being mainly affected [36]. Hypophysitis, thyroid dysfunction, type 1 diabetes mellitus (T1DM), central diabetes insipidus, and PAI are ICI-induced endocrine irAEs [37,38]. Causative and risk factors eliciting the endocrine system's involvement (and other organs) in ICI-related toxicity are currently unknown.…”
Section: Ici-induced Adrenal Insufficiencymentioning
confidence: 99%
“…However, other endocrine glands may be more rarely affected (adrenals, parathyroids, pancreas), and metabolic abnormalities have also been described [ 7 , 8 ]. Recently, central diabetes insipidus (CDI) has been reported as an irAE deriving from the dysfunction of posterior pituitary/hypothalamus in patients who are receiving treatment with ICI [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Herein, we briefly summarize the current evidence regarding ICI-induced injury to the hypothalamus–pituitary axis.…”
Section: Introductionmentioning
confidence: 99%
“…Thyroid dysfunctions are the most common side effects of immunotherapy, affecting 30% of treated patients. Hypothyroidism is more common in patients treated with PD-1 inhibitors and in combination therapies [ 20 ], and although adverse events are usually immune-mediated, it is caused by autoimmune thyroiditis in only 45% of cases [ 21 ]. PD-1 inhibitors are also associated with an increased risk of hyperthyroidism, which is usually transient and followed by hypothyroidism, although cases of Graves’ disease and thyroid eye disease have also been described [ 21 ].…”
mentioning
confidence: 99%
“…Contrary to thyroid changes, hypophysitis is more associated with CTLA-4 inhibitors, but again, combination therapy increases the risk [ 22 ]. Patients may have both a bulking effect, due to increased pituitary tissue, and hormonal insufficiency: isolated adrenocorticotropic hormone (ACTH) deficiency is more common in patients treated with PD-1 and PD-L1, while CTLA-4 inhibitors usually cause multiple anterior pituitary insufficiency [ 21 ]. The concomitant development of diabetes insipidus and anterior pituitary deficiency due to CTLA-4 inhibitors has been rarely described.…”
mentioning
confidence: 99%
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