Xiao Yan, Jiang Deyue, Wang Shengjie, Fu Lei, Ye Lingtong, Zheng Erhan, Lv Zhaohui, Mu Yiming, Gong Wenwen, Guo Qinghua
Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Clinical Medicine, The Capital Medical University, Beijing, 100069, China.
Sci Rep. 2025 Jul 1;15(1):21353. doi: 10.1038/s41598-025-05563-3.
This study aims to investigate the clinical characteristics of programmed cell death protein-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibitors-induced pituitary injury (pituitary-irAE) by comparing with other pituitary diseases. We retrospectively reviewed clinical records of patients who were admitted for pituitary-irAE, idiopathic isolated ACTH deficiency (IIAD), and lymphocytic hypophysitis (LYH) from January 2015 to June 2024. Among 3689 patients treated with PD-1/PD-L1 inhibitors, 0.596% patients developed pituitary-irAE. The mean age of onset was 59.41 ± 10.69 years, with 13 patients (59.09%) being male. The median duration from symptom onset to confirmed diagnosis was 5.50 (2.00, 9.25) months. The clinical symptoms were similar between pituitary-irAE and IIAD, which mainly manifested as fatigue and appetite loss. Polydipsia/polyuria and amenorrhea/menstrual disorders were mainly found in patients with LYH. Central adrenal insufficiency was observed in all patients with pituitary-irAE, with cortisol concentrations typically falling below the detectable limit. Pituitary MRI appeared normal in 52.63% patients with pituitary-irAE. Furthermore, some patients with pituitary-irAE exhibited partial or complete functional recovery of the pituitary gland after hormone replacement therapy. The clinical manifestations observed in patients with pituitary-irAE are analogous to those seen in individuals with IIAD, yet they differ from the presentations of LYH.
本研究旨在通过与其他垂体疾病进行比较，调查程序性细胞死亡蛋白1（PD-1）或程序性细胞死亡配体1（PD-L1）抑制剂诱导的垂体损伤（垂体免疫相关不良反应）的临床特征。我们回顾性分析了2015年1月至2024年6月因垂体免疫相关不良反应、特发性孤立性促肾上腺皮质激素缺乏症（IIAD）和淋巴细胞性垂体炎（LYH）入院患者的临床记录。在3689例接受PD-1/PD-L1抑制剂治疗的患者中，0.596%的患者发生了垂体免疫相关不良反应。发病的平均年龄为59.41±10.69岁，男性患者13例（59.09%）。从症状出现到确诊的中位时间为5.50（2.00，9.25）个月。垂体免疫相关不良反应和IIAD的临床症状相似，主要表现为疲劳和食欲减退。多饮/多尿和闭经/月经紊乱主要见于LYH患者。所有垂体免疫相关不良反应患者均观察到中枢性肾上腺功能不全，皮质醇浓度通常降至可检测限以下。52.63%的垂体免疫相关不良反应患者垂体MRI表现正常。此外，一些垂体免疫相关不良反应患者在激素替代治疗后垂体功能出现部分或完全恢复。垂体免疫相关不良反应患者的临床表现与IIAD患者相似，但与LYH的表现不同。
