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

Lijuan Yang; Yao Zhang; Xiaoyu Chen; Kuanzhi Liu; Yaru Zhou; Shuchang Wang

doi:10.1111/cen.15075

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

Clin Endocrinol (Oxf). 2024 May 16. doi: 10.1111/cen.15075. Online ahead of print.

Authors

Lijuan Yang¹, Yao Zhang², Xiaoyu Chen³, Kuanzhi Liu¹, Yaru Zhou¹, Shuchang Wang¹

Affiliations

¹ Department of Endocrinology, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
² Department of Endocrinology, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
³ Department of Geriatrics, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

PMID: 38753540
DOI: 10.1111/cen.15075

Abstract

Objective: We 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 measurements: We 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.

Results: Among 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.

Conclusion: In our study, pituitary immune-related adverse reactions induced by PD-1 inhibitors mainly manifested isolated ACTH deficiency rather than hypophysitis.

Keywords: CTLA‐4 inhibitors; PD‐1 inhibitors; hypophysitis; immune checkpoint inhibitor (ICIs); immune‐related adverse events (irAEs); isolated adrenocorticotropic hormone (ACTH) deficiency (IAD).

Abstract

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