Rajan Remya, Nandakumar Devika
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2025 Jul-Aug;29(4):408-413. doi: 10.4103/ijem.ijem_47_25. Epub 2025 Aug 26.
Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy by enhancing T-cell-mediated tumour eradication. However, their use is associated with immune-related adverse events, with endocrinopathies being the most common. Thyroid dysfunction, hypophysitis, primary adrenal insufficiency (PAI), and insulin-dependent diabetes mellitus are well-documented complications. Thyroid dysfunction typically follows a biphasic course, with transient thyrotoxicosis progressing to hypothyroidism. Hypophysitis primarily affects the anterior pituitary, often leading to isolated adrenocorticotropic hormone deficiency. ICI-induced diabetes mellitus results from autoimmune β-cell destruction, frequently presenting as diabetic ketoacidosis. Primary adrenal insufficiency is rare but requires prompt recognition. Despite these endocrine toxicities, the benefits of ICIs outweigh their risks, and treatment is usually continued with appropriate hormone replacement. Early recognition and management of these endocrinopathies are crucial for optimising patient outcomes. This review summarises the incidence, pathophysiology, diagnosis, and management of ICI-associated endocrine disorders, providing essential insights for oncologists and endocrinologists.
免疫检查点抑制剂（ICIs）通过增强T细胞介导的肿瘤清除作用，彻底改变了癌症治疗方式。然而，其使用与免疫相关不良事件有关，其中内分泌病最为常见。甲状腺功能障碍、垂体炎、原发性肾上腺皮质功能减退（PAI）和胰岛素依赖型糖尿病是有充分文献记载的并发症。甲状腺功能障碍通常呈双相病程，短暂的甲状腺毒症会发展为甲状腺功能减退。垂体炎主要影响垂体前叶，常导致孤立性促肾上腺皮质激素缺乏。ICI诱导的糖尿病是由自身免疫性β细胞破坏引起的，常表现为糖尿病酮症酸中毒。原发性肾上腺皮质功能减退很少见，但需要及时识别。尽管存在这些内分泌毒性，但ICIs的益处大于风险，通常会继续进行适当的激素替代治疗。早期识别和管理这些内分泌病对于优化患者预后至关重要。本综述总结了ICI相关内分泌疾病的发病率、病理生理学、诊断和管理，为肿瘤学家和内分泌学家提供了重要见解。
