Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, Korea.
Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2024 Sep;39(5):801-812. doi: 10.3904/kjim.2023.523. Epub 2024 Aug 30.
BACKGROUND/AIMS: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events, including endocrine dysfunctions, which can have serious consequences on patient health and quality of life. The clinical course and characteristics of immune-related hypophysitis (irH) are not well established. This study aimed to analyze the clinical course and characteristics of irH.
This single-center, retrospective study analyzed data from electronic medical records of Asan Medical Center, spanning January 2017 through June 2021. It included adult patients with solid tumors who underwent thyroid and adrenal function tests, along with gonadotropin and/or growth hormone evaluations, following the initiation of ICI treatment within the same period. The study explored the clinical characteristics of ICI-treated patients with and without irH, the incidence of irH, the time to irH onset, and the associated hormonal changes.
Twenty-one patients were included in this analysis. Clinical characteristics did not differ significantly between the irH (n = 13) and non-irH (n = 8) groups. Deficiency rates in the irH group were 23.1% for thyroid-stimulating hormone (n = 3), 76.9% for adrenocorticotropic hormone (n = 10), 61.5% for gonadotropin (n = 8), and 15.4% for growth hormone (n = 2). The overall incidence was 0.9 per person-year, with 6-month and 1-year cumulative incidences of 38.8% and 57.1%, respectively. The median time from ICI initiation to irH diagnosis was 7.7 months. Time to levothyroxine replacement was shorter in the irH group.
The findings provide evidence that could facilitate the prediction of ICI-induced irH based on clinical course and characteristics.
背景/目的：免疫检查点抑制剂（ICI）可引发免疫相关不良反应，包括内分泌功能紊乱，这可能对患者的健康和生活质量产生严重影响。免疫相关垂体炎（irH）的临床病程和特征尚未得到充分确立。本研究旨在分析 irH 的临床病程和特征。
这是一项单中心、回顾性研究，分析了 2017 年 1 月至 2021 年 6 月期间在 Asan 医疗中心接受电子病历数据的患者，这些患者在同一时期内接受 ICI 治疗后，进行了甲状腺和肾上腺功能检测，以及促性腺激素和/或生长激素评估。研究探讨了接受 ICI 治疗的伴有和不伴有 irH 的患者的临床特征、irH 的发生率、irH 发病时间以及相关的激素变化。
本研究共纳入 21 例患者。irH 组（n = 13）和非 irH 组（n = 8）的临床特征无显著差异。irH 组的甲状腺刺激激素缺乏率为 23.1%（n = 3），促肾上腺皮质激素缺乏率为 76.9%（n = 10），促性腺激素缺乏率为 61.5%（n = 8），生长激素缺乏率为 15.4%（n = 2）。总体发生率为 0.9 人年，6 个月和 1 年的累积发生率分别为 38.8%和 57.1%。从 ICI 开始到 irH 诊断的中位时间为 7.7 个月。irH 组开始使用左甲状腺素替代治疗的时间更短。
这些发现为根据临床病程和特征预测 ICI 诱导的 irH 提供了证据。
