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Pituitary-related immune adverse events induced by programmed death Protein-1 inhibitors differ clinically from hypophysitis

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机构: [1]Hebei Med Univ, Hosp 3, Dept Endocrinol, 139 Ziqiang Rd, Shijiazhuang 050051, Hebei, Peoples R China [2]Hebei Univ, Affiliated Hosp, Dept Endocrinol, Baoding, Hebei, Peoples R China [3]Hebei Med Univ, Hosp 3, Dept Geriatr, Shijiazhuang, Hebei, Peoples R China
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关键词: CTLA-4 inhibitors hypophysitis immune checkpoint inhibitor (ICIs) immune-related adverse events (irAEs) isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) PD-1 inhibitors

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ObjectiveWe aimed to elucidate the clinical features of pituitary immune-related adverse events (irAEs) induced by PD-1 inhibitors in a Chinese cohort and the previous literatures.Patients and Design and MeasurementsWe retrospectively analysed the clinical manifestations, laboratory examination findings, imaging features and treatments of 14 patients with pituitary irAEs caused by PD-1 inhibitors in our cohort. In addition, we searched PubMed for all English articles on pituitary irAEs induced by PD-1 inhibitors published from 1950 to 2023. A total of 47 articles were included, and the clinical characteristics of 94 patients with pituitary irAEs induced by PD-1 inhibitors in these literatures were compared to the characteristics of our cohort.ResultsAmong the 14 patients in our cohort with pituitary irAEs induced by PD-1 inhibitors, 12 patients (85.71%, 12/14) exhibited isolated ACTH deficiency (IAD), 100.0% (14/14) of the central adrenocortical insufficiency, and 2 patients showed more than one hypothalamic-pituitary axis injury (14.29%, 2/14). Pituitary magnetic resonance imaging in all the 14 patients showed no pituitary enlargement. In previous studies we reviewed, 82.98% of the total (78/94) presented with pituitary irAEs as IAD, 100.0% (94/94) of the central adrenocortical insufficiency, and 78.33% of the patients showed no abnormality of the pituitary gland (47/60). The pituitary irAEs caused by PD-1 inhibitors did not involve typical manifestations of hypophysitis, such as pituitary enlargement, headache, visual field defects, and multiple pituitary function impairments in our cohort and the previous literatures.ConclusionIn our study, pituitary immune-related adverse reactions induced by PD-1 inhibitors mainly manifested isolated ACTH deficiency rather than hypophysitis.

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大类 | 3 区 医学
小类 | 3 区 内分泌学与代谢
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Q2 ENDOCRINOLOGY & METABOLISM

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第一作者机构: [1]Hebei Med Univ, Hosp 3, Dept Endocrinol, 139 Ziqiang Rd, Shijiazhuang 050051, Hebei, Peoples R China
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