Mizukoshi Tadashi, Fukuoka Hidenori, Takahashi Yutaka
Kobe University School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Best Pract Res Clin Endocrinol Metab. 2022 May;36(3):101668. doi: 10.1016/j.beem.2022.101668. Epub 2022 May 6.
Immune checkpoint inhibitors (ICIs) have been recently proposed as a strategy for treating anti-malignant neoplasms. However, this treatment leads to immune-related adverse events (irAEs) such as autoimmune endocrinopathy. Early diagnosis and appropriate treatment of ICI-related hypophysitis are essential as it can manifest as a life-threatening condition due to an adrenal crisis. In this review, we summarize the pathogenesis, risk factors, diagnostic processes, clinical characteristics, and its current management. In particular, we discuss the different aspects of anti-CTLA-4 antibody-related and anti-PD-1/anti-PD-L1 antibody-related hypophysitis. We also propose key points for early detection and diagnosis by identifying the target group that should be monitored more carefully. Specific methods of hormone replacement therapy have also been described. We hope that this review will lead to a better understanding and management of this rare but serious condition during cancer treatment and further elucidate the pathophysiology of pituitary autoimmunity.
免疫检查点抑制剂(ICIs)最近被提议作为一种治疗抗恶性肿瘤的策略。然而,这种治疗会导致免疫相关不良事件(irAEs),如自身免疫性内分泌病。早期诊断和适当治疗ICI相关的垂体炎至关重要,因为它可能因肾上腺危象而表现为危及生命的状况。在本综述中,我们总结了其发病机制、危险因素、诊断过程、临床特征及其当前的管理方法。特别是,我们讨论了抗CTLA-4抗体相关和抗PD-1/抗PD-L1抗体相关垂体炎的不同方面。我们还通过确定应更仔细监测的目标群体,提出了早期检测和诊断的关键点。还描述了激素替代疗法的具体方法。我们希望本综述将有助于在癌症治疗期间更好地理解和管理这种罕见但严重的疾病,并进一步阐明垂体自身免疫的病理生理学。