Iwama Shintaro, Kobayashi Tomoko, Arima Hiroshi
Department of Endocrinology and Diabetes, Nagoya University Hospital, Nagoya, Japan.
Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nat Rev Endocrinol. 2025 May;21(5):289-300. doi: 10.1038/s41574-024-01077-6. Epub 2025 Jan 9.
Immune-related adverse events (irAEs), including endocrine irAEs, can occur in response to cancer immunotherapy using immune checkpoint inhibitors (ICIs). Of the endocrine irAEs, pituitary and thyroid irAEs are most frequently observed, followed by primary adrenal insufficiency, type 1 diabetes mellitus and hypoparathyroidism. Notably, pituitary irAEs and type 1 diabetes mellitus can be lethal if overlooked, potentially leading to adrenal crisis and diabetic ketoacidosis, respectively. On the other hand, pituitary and thyroid irAEs are reported to be associated with more favourable prognoses in some cancers if treated appropriately with hormone-replacement therapies. It would be useful to identify those people who are likely to develop endocrine irAEs before initiating therapy with ICIs. Anti-pituitary antibodies and thyroid autoantibodies have been identified as potential biomarkers for the development of pituitary and thyroid irAEs, respectively. This Review elaborates on the clinical characteristics and management strategies of several endocrine irAEs, using the latest research findings and guidelines published by several academic societies.
免疫相关不良事件（irAEs），包括内分泌irAEs，可发生于使用免疫检查点抑制剂（ICI）的癌症免疫治疗过程中。在内分泌irAEs中，垂体和甲状腺irAEs最为常见，其次是原发性肾上腺功能不全、1型糖尿病和甲状旁腺功能减退。值得注意的是，垂体irAEs和1型糖尿病若被忽视可能会致命，分别可能导致肾上腺危象和糖尿病酮症酸中毒。另一方面，据报道，垂体和甲状腺irAEs如果通过激素替代疗法得到适当治疗，在某些癌症中与更有利的预后相关。在开始ICI治疗之前识别出可能发生内分泌irAEs的人群将很有帮助。抗垂体抗体和甲状腺自身抗体已分别被确定为垂体和甲状腺irAEs发生的潜在生物标志物。本综述利用几个学术协会发表的最新研究结果和指南，阐述了几种内分泌irAEs的临床特征和管理策略。
