Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2019 Jan;118(1 Pt 3):524-529. doi: 10.1016/j.jfma.2018.07.014. Epub 2018 Aug 10.
Immune checkpoint blockade-based immunotherapy is a new modality of cancer treatment with a unique mechanism that has gained increased numbers of indication and is now used in several cancer types. However, immune-related adverse events (irAEs) emerge as a new entity of diseases involving one or multiple organ systems. irAEs could result in interruption of immunotherapy, morbidities or even death. Among various manifestations of irAEs, immune-mediated hypophysitis is rare but important, requiring prompt diagnosis and treatment to avoid life-threatening conditions. We report seven cases of immune-mediated hypophysitis in Taiwan. They suffered from various types of advanced cancer and received different regimens of immune checkpoint inhibitors. The time of onset after initiation of immunotherapy ranged from 5 to 36 weeks. All seven subjects were diagnosed of central adrenal insufficiency, while four of them had primary hypothyroidism. There was no typical finding of infiltrative hypophysitis on the pituitary MRI. There was no documented hormone recovery after diagnosis of hypophysitis, and the tumor responses to immunotherapy were variable in these seven patients. In conclusion, immune-mediated hypophysitis is often irreversible. Fortunately, it can be managed adequately with hormone replacements. Further investigations are warranted to unveil underlying mechanisms and ethnic differences to guide the solutions.
免疫检查点阻断的免疫疗法是一种新的癌症治疗模式，具有独特的机制，已获得越来越多的适应证，现被用于多种癌症类型。然而，免疫相关不良事件（irAEs）作为一种涉及一个或多个器官系统的新疾病实体出现。irAEs 可导致免疫治疗中断、产生发病率，甚至导致死亡。在 irAEs 的各种表现中，免疫介导性垂体炎虽罕见但很重要，需要及时诊断和治疗，以避免危及生命的情况。我们报告了台湾的 7 例免疫介导性垂体炎。这些患者患有各种晚期癌症，并接受了不同的免疫检查点抑制剂治疗方案。免疫治疗开始后发病时间从 5 周到 36 周不等。所有 7 例患者均被诊断为中枢性肾上腺功能不全，其中 4 例患者患有原发性甲状腺功能减退症。垂体 MRI 上无浸润性垂体炎的典型表现。在诊断为垂体炎后，没有记录到激素恢复的情况，这 7 例患者对免疫治疗的肿瘤反应各不相同。总之，免疫介导性垂体炎往往是不可逆的。幸运的是，它可以通过激素替代治疗得到充分控制。需要进一步的研究来揭示潜在的机制和种族差异，以指导解决方案。
