Title:Immunotherapy-Associated Hypophysitis under Anti-PD1: Two Case
Reports
Volume: 23
Issue: 7
Author(s): Xinyu Shen, Minglan Yang, Hua Xu, Huan Zhou, Liwei Wang and Jing Ma*
Affiliation:
- Department of Endocrinology and Metabolic Diseases, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine,
Shanghai, China
Keywords:
Pituitary-irAE, immune checkpoint inhibitors, PD-1, immunotherapy-associated hypophysitis, hormone replacement therapy, immunotherapy.
Abstract:
Background: Immunotherapy-associated hypophysitis is an uncommon adverse event.
However, if not handled properly, it could lead to fatal sequelae.
Case Presentations: Case 1. A 66-year-old man presented to our hospital with hyponatremia. He
had low plasma levels of adrenocorticotropin and cortisol. The patient had a history of non-small
cell lung cancer and had undergone 16 cycles of immunotherapy with sintilimab, a monoclonal
antibody against programmed cell death protein 1 (PD1). He was diagnosed with adrenal insufficiency
secondary to immunotherapy-associated hypophysitis and received a physiological dose of
glucocorticoids. Upon discharge, he has prescribed a continued course of hormone replacement
therapy combined with immunotherapy. Case 2. The second case profiled here involved a 58-
year-old patient diagnosed with gastric antrum cancer. After ten months of immunotherapy with
carrelizumab, a human high-affinity immunoglobulin G4 (IgG4) anti-PD-1 monoclonal antibody
drug, the patient was referred to the Endocrinology Department at our medical centre for adrenal
nodules and intolerance of anorexia. He also suffered from hypophysitis and was prescribed hormone
replacement therapy combined with immunotherapy.
Conclusion: This article discusses the clinical characteristics, diagnosis, treatment, and subsequent
follow-up for immunotherapy-associated hypophysitis in the context of two case reports.
Based on our findings and observations, we conclude that patients with immunotherapy should
regularly be referred to endocrine-related follow-up during tumour treatment.
