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Immunotherapy-Related Hypophysitis: A Narrative Review
by
,
Vincenza Di Stasi
1,†, 
Domenico La Sala
2,*,†,
Renato Cozzi
3,
Francesco Scavuzzo
4,
Vincenzo De Geronimo
5,
Maurizio Poggi
6,
Mario Vitale
7 and
Anna Tortora
8,* 1
Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroentherology IRCCS Saverio De Bellis, 70013 Castellana Grotte, Italy
2
UOSD Malattie Endocrine Nutrizione e Ricambio, AORN, San Giuseppe Moscati, 83100 Avellino, Italy
3
Endocrine Unit Grande Ospedale Metropolitano, Niguarda, 20162 Milano, Italy
4
UOC Endocrinologia AORN A. Cardarelli, 80131 Napoli, Italy
5
Centro Clinico Diagnostico GB Morgagni srl, 95125 Catania, Italy
6
UOC Medicina Specialistica Endocrino-Metabolica, AOU Sant’Andrea, 00189 Roma, Italy
7
Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, 84081 Baronissi, Italy
8
UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2025, 17(3), 436; https://doi.org/10.3390/cancers17030436
Submission received: 30 November 2024
/
Revised: 17 January 2025
/
Accepted: 23 January 2025
/
Published: 27 January 2025
(This article belongs to the Section Cancer Immunology and Immunotherapy)
Simple Summary
Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but are associated with immune-related side effects, including hypophysitis, which can significantly impair endocrine function. This review delves into the pathogenesis, clinical manifestations, diagnosis, and management of ICI-induced hypophysitis, emphasizing its diagnostic challenges due to symptom overlap with the underlying cancer. Accurate diagnosis requires a combination of clinical assessment, hormonal evaluation, and imaging studies. Management strategies center on tailored hormone replacement therapy and close monitoring. Early detection and prompt intervention are essential to enhancing patient outcomes and quality of life. This review aims to improve healthcare providers’ understanding and awareness of this complex and demanding condition.
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized oncology, providing a groundbreaking therapeutic option for patients with various advanced-stage cancers. While these treatments can significantly extend survival, they also carry a substantial risk of immune-related adverse events, among which hypophysitis is particularly detrimental to endocrine function. This narrative review synthesizes current knowledge on the pathogenesis, clinical features, diagnosis, and management of ICI-induced hypophysitis (IH) based on an in-depth analysis of the recent literature and clinical trials. The diagnosis of IH presents unique challenges due to its overlap with systemic symptoms commonly associated with the underlying malignancy. These symptoms can include asthenia, anorexia, headache, vomiting, weight loss, hypotension, dizziness, decreased libido, and visual disturbances. Diagnostic evaluation typically combines clinical assessment, hormonal profiling, and findings from magnetic resonance imaging (MRI). Effective management of IH requires a personalized, multidisciplinary approach, focusing on hormone replacement therapy and vigilant monitoring. Long-term care depends on the severity of hypophysitis, and the specific hormonal axes involved. This review aims to enhance awareness of the critical aspects of recognizing and managing IH, underscoring the importance of early diagnosis and timely intervention to reduce its long-term effects on patient quality of life.
Keywords:
Immune checkpoint inhibitors; hypophysitis; Immunotherapy
