A Novel Etiology of Hypophysitis: Immune Checkpoint Inhibitors

Abstract

Checkpoint inhibitors trigger an immune process against cancer cells while causing cytotoxicity and self-antibody production against normal cells. Hypophysitis is a common endocrine toxicity. Hypophysitis may occur at any time during and after therapy, necessitating close clinical monitoring and screening for pituitary deficiencies. Treatment with high-dose glucocorticoids and temporary cessation of immunotherapy is indicated for severe hypophysitis with intractable headaches and vision changes, and for adrenal crisis. Increased awareness about this novel hypophysitis and multidisciplinary collaboration are needed to improve outcomes. This article reviews the function of immune checkpoint inhibitors and pituitary adverse effects with immune checkpoint inhibitor use.

Keywords: Adrenal insufficiency; Cytotoxic T-lymphocyte-associated protein 4; Endocrine dysfunction; Hypophysitis; Immune checkpoint inhibitors; Immunotherapy; Programmed cell death; T lymphocytes.