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Immune-Related Endocrinopathies: Recognition and Replacement

Checkpoint inhibitor endocrine toxicities including thyroid, hypophysitis and adrenal insufficiency

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Immune-Related Endocrinopathies: Recognition and Replacement?

Immune-related endocrinopathies result from immunotherapy-mediated inflammation and damage to endocrine glands.

Most common are thyroid dysfunction (hypothyroidism, thyrotoxicosis), hypophysitis, primary adrenal insufficiency and rare type 1 diabetes mellitus.

Thyroid disease occurs in 5 to 15 percent with anti-PD-1/PD-L1, often with thyrotoxic phase followed by hypothyroidism.

Hypophysitis is more common with anti-CTLA-4, presents with multiple anterior pituitary deficiencies and pituitary enlargement on MRI.

Most endocrinopathies cause permanent gland dysfunction unlike other immune-related events; lifelong hormone replacement is often needed.

Symptoms

Hypothyroidism causes fatigue, cold intolerance, weight gain, constipation and bradycardia.
Thyrotoxicosis presents with palpitations, tremor, heat intolerance, weight loss and anxiety.
Hypophysitis causes severe headache, fatigue, hyponatremia, hypotension and visual disturbances.
Adrenal insufficiency manifests as fatigue, weight loss, hypotension, electrolyte abnormalities and adrenal crisis.
Type 1 diabetes presents with hyperglycemia, polyuria, weight loss and may cause diabetic ketoacidosis.

Risk Factors

Higher incidence with anti-CTLA-4 monotherapy, particularly hypophysitis.
Combination immunotherapy with anti-CTLA-4 and anti-PD-1 increases risk substantially.
Pre-existing autoimmune endocrine disease.
Family history of autoimmune endocrinopathies.
Female sex with higher rates of thyroid dysfunction and male sex with higher hypophysitis incidence.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Symptoms suggestive of hypothyroidism, thyrotoxicosis, adrenal crisis or hypophysitis require prompt evaluation.
  • Severe headache with vision changes, hypotension, severe fatigue or vomiting may indicate adrenal or pituitary emergency.
  • Polyuria, polydipsia, severe hyperglycemia or signs of diabetic ketoacidosis warrant urgent intervention.
  • Routine laboratory surveillance abnormalities should prompt clinical correlation and endocrinology referral.
  • Long-term endocrinology follow-up monitors hormone replacement adequacy and adjusts therapy as needed.

Treatment Methods

01
Hypothyroidism is treated with levothyroxine titrated to TSH levels with no need to hold immunotherapy in most cases.
02
Thyrotoxicosis may require beta-blockers, careful monitoring and treatment of subsequent hypothyroidism.
03
Hypophysitis requires immediate hydrocortisone replacement and high-dose corticosteroids in select cases for mass effect; thyroid and gonadal hormone replacement based on deficiencies.
04
Adrenal insufficiency necessitates physiologic hydrocortisone and fludrocortisone replacement and stress dosing during illness.
05
Type 1 diabetes requires insulin therapy and immunotherapy continuation in most cases; patient education on emergency dosing, identification bracelets and coordinated care between oncology and endocrinology ensures comprehensive management.

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.