Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK.
Eur J Endocrinol. 2012 Jul;167(1):1-5. doi: 10.1530/EJE-12-0167. Epub 2012 Apr 10.
Ipilimumab (Yervoy; Medarex and Bristol-Myers Squibb) is a human MAB against cytotoxic T-lymphocyte antigen 4, which enhances co-stimulation of cytotoxic T-lymphocytes, resulting in their proliferation and an anti-tumour response. It is licensed for the treatment of unresectable or metastatic malignant melanoma, while multiple clinical trials using this medication in the treatment of other malignancies are ongoing. As a clinical response to ipilimumab results from immunostimulation, predictably it generates autoimmunity as well, causing immune-related adverse events in the majority of patients. Of those, endocrinopathies are frequently seen, and in particular, autoimmune lymphocytic hypophysitis with anterior panhypopituitarism has been reported a number of times in North America. We present a case of a male referred to our department with manifestations of anterior panhypopituitarism after his third dose of ipilimumab for metastatic malignant melanoma, and we discuss the management of his case in the light of previous reports. We also review the published literature on the presenting symptoms, time to presentation, investigations, imaging, treatment and follow-up of ipilimumab-induced autoimmune lymphocytic hypophysitis.
依匹单抗（Yervoy；Medarex 和 Bristol-Myers Squibb）是人源 CTLA-4 单抗，可增强细胞毒性 T 淋巴细胞的共刺激，导致其增殖和抗肿瘤反应。它被批准用于治疗不可切除或转移性恶性黑色素瘤，而正在进行多项临床试验，以评估该药在其他恶性肿瘤中的应用。由于依匹单抗的临床反应源于免疫刺激，因此它不可避免地也会产生自身免疫，导致大多数患者出现免疫相关不良事件。其中，内分泌疾病较为常见，特别是自身免疫性淋巴细胞性垂体炎伴全垂体前叶功能减退症，在北美已多次报道。我们报告了 1 例转移性恶性黑色素瘤患者在接受第 3 次依匹单抗治疗后出现全垂体前叶功能减退症的表现，并根据以往的报道讨论了该患者的治疗方法。我们还回顾了关于依匹单抗诱导的自身免疫性淋巴细胞性垂体炎的临床表现、出现时间、检查、影像学、治疗和随访的文献。
