Immune checkpoint inhibitor-induced hypophysitis: clinical and biochemical features

Esteves-Ferreira, Sara; Rosinha, Patrícia

doi:10.1007/s00432-023-04659-5

Cited by 7 publications

(3 citation statements)

References 41 publications

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“…The hallmark endocrine abnormality is secondary adrenocortical insufficiency resulting from diminished ACTH secretion by the adenohypophysis, leading to reduced cortisol production and release from the adrenal glands. This may manifest as fatigue, anorexia, nausea and vomiting, fever of unknown causes, varying degrees of cognitive dysfunction, hypotension, hypoglycemia, obstinate hyponatremia, and other symptoms [ 13 , 14 ]. In imaging manifestations, Studies have demonstrated that hypophysitis resulting from CTLA-4 blockade typically leads to panhypopituitarism with mild pituitary enlargement, while the PD-1 blockade group is characterized by isolated severe ACTH deficiency without mass effect symptoms and imaging abnormalities [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Hypophysitis Induced by Sintilimab in the Treatment of Bladder Cancer: A Case Report

Li,

Jiang,

Zhu

et al. 2024

EMIDDT

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Background: Immune checkpoint inhibitors (ICIs), as novel antitumor drugs, have been widely used in the clinic and have shown good antitumor effects. However, their widespread use has also led to the emergence of various immune-related adverse events (IrAEs). Hypophysitis is a rare but serious IrAE. Due to its complex and changeable clinical manifestations, hypophysitis may be easily overlooked, leading to delayed diagnosis and treatment. Case Presentation: A 68-year-old male patient was diagnosed with bladder cancer (T2bNXM0) in October 2021. He received two cycles of immunotherapy with sintilimab and chemotherapy with gemcitabine and cisplatin (GC). One month after the second treatment, he gradually developed recurrent fever, anorexia, drowsiness, and delirium. Laboratory examination revealed hyponatremia, decreased adrenocorticotropic hormone, and hypocortisolemia. The pituitary MRI showed no abnormality. The patient was diagnosed with immunotherapy-induced hypophysitis (IH) caused by sintilimab, leading to downstream endocrine disorders. With hormone replacement therapy, he was in a good mood, had a good appetite, and made an overall recovery. Conclusion: Immunotherapy-induced hypophysitis (IH) can result in a severe adrenal crisis, and prompt recognition and diagnosis are crucial. Clinicians must remain vigilant for the possibility of IH in patients who exhibit recurrent fever, anorexia, cognitive decline, and personality changes following ICI treatment. It is imperative to consider this diagnosis early to initiate appropriate management promptly.

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Section: Discussionmentioning

confidence: 99%

Hypophysitis Induced by Sintilimab in the Treatment of Bladder Cancer: A Case Report

Li,

Jiang,

Zhu

et al. 2024

EMIDDT

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“…Additionally, studies showed that immunotherapy drugs may directly or indirectly cause neurological side effects, including dizziness [7], and interactions between immunotherapy drugs and other medications can also lead to dizziness. Furthermore, lung cancer affects lung function, potentially leading to hypoxemia, which in turn can cause dizziness.…”

Section: Lung Patients Encounter Various Clusters Throughout Immunoth...mentioning

confidence: 99%

Symptom Clusters and Symptom Network Analysis During Immunotherapy in Lung Cancer Patients

Yang,

Bai,

liu

et al. 2024

Preprint

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Objective: This study aimed to analyze symptoms in lung cancer patients undergoing immunotherapy and to identify core symptom clusters through network analysis, thereby laying the groundwork for effective symptom management programs. Methods: The study involved 240 lung cancer patients receiving immunotherapy. Participants were assessed using the memory symptom scale. Exploratory factor analysis extracted symptoms, and network analysis using JASP 0.17.3 explored centrality indices and density in these symptom networks. Results: Five symptom clusters were identified: emotion-related, lung cancer-specific, perception, skin, and neurological symptom clusters, with a cumulative variance contribution rate of 55.819%. Network analysis revealed sadness as the most intense symptom (rs = 2.189), dizziness as the most central (rc = 1.388), and fatigue as the most significant bridging symptom (rB = 2.575). Conclusion: This study identified five symptom clusters and networks during the immunotherapy in lung cancer patients. The centrality indices and network density from the network analysis can assist healthcare professionals in devising more precise symptom management strategies.

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“…A recent analysis of VigiBase, a global database of the WHO, found that endocrine diseases caused by ICIs are reported more frequently, more so in combination therapy [56]. The main clinical consequence of ICI-related hypophysitis is deficiency of one or more pitu-itary hormones such as the thyroid stimulating hormone (TSH), the adrenocorticotropic hormone (ACTH), the follicle stimulating hormone (FSH), and the luteinizing hormone (LH) [57]. Since the pituitary gland plays a key role in the regulation of the ovaries and testes, its dysregulation can lead to serious damage such as premature menopause and low testosterone levels with subsequent erectile dysfunction and decreased sperm production.…”

Section: Icis' Impact On Female Fertilitymentioning

confidence: 99%

Fertility Preservation in the Era of Immuno-Oncology: Lights and Shadows

Silvestris,

D’Oronzo,

Petracca

et al. 2024

JPM

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In recent years, immuno-oncology has revolutionized the cancer treatment field by harnessing the immune system’s power to counteract cancer cells. While this innovative approach holds great promise for improving cancer outcomes, it also raises important considerations related to fertility and reproductive toxicity. In fact, most young females receiving gonadotoxic anti-cancer treatments undergo iatrogenic ovarian exhaustion, resulting in a permanent illness that precludes the vocation of motherhood as a natural female sexual identity. Although commonly used, oocyte cryopreservation for future in vitro fertilization and even ovarian cortex transplantation are considered unsafe procedures in cancer patients due to their oncogenic risks; whereas, ovarian stem cells might support neo-oogenesis, providing a novel stemness model of regenerative medicine for future fertility preservation programs in oncology. Recent scientific evidence has postulated that immune checkpoint inhibitors (ICIs) might in some way reduce fertility by inducing either primary or secondary hypogonadism, whose incidence and mechanisms are not yet known. Therefore, considering the lack of data, it is currently not possible to define the most suitable FP procedure for young patients who are candidates for ICIs. In this report, we will investigate the few available data concerning the molecular regulation of ICI therapy and their resulting gonadal toxicity, to hypothesize the most suitable fertility preservation strategy for patients receiving these drugs.

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Immune checkpoint inhibitor-induced hypophysitis: clinical and biochemical features

Cited by 7 publications

References 41 publications

Hypophysitis Induced by Sintilimab in the Treatment of Bladder Cancer: A Case Report

Hypophysitis Induced by Sintilimab in the Treatment of Bladder Cancer: A Case Report

Symptom Clusters and Symptom Network Analysis During Immunotherapy in Lung Cancer Patients

Fertility Preservation in the Era of Immuno-Oncology: Lights and Shadows

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