Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events
ObjectiveTo explore the clinical characteristics of immune-related adverse events (irAEs) involving the pituitary gland in malignant tumor patients following the administration of immune checkpoint inhibitors (ICIs), and to compare characteristics of pituitary irAEs with primary hypophysitis. Method...
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Shanghai Chinese Clinical Medicine Press Co., Ltd.
2025-08-01
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| Series: | Zhongguo Linchuang Yixue |
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| Online Access: | https://www.c-jcm.com/article/doi/10.12025/j.issn.1008-6358.2025.20250323 |
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| author | Yufan ZHENG Jingjing WANG Qin YUAN Fenping ZHENG |
| author_facet | Yufan ZHENG Jingjing WANG Qin YUAN Fenping ZHENG |
| author_sort | Yufan ZHENG |
| collection | DOAJ |
| description | ObjectiveTo explore the clinical characteristics of immune-related adverse events (irAEs) involving the pituitary gland in malignant tumor patients following the administration of immune checkpoint inhibitors (ICIs), and to compare characteristics of pituitary irAEs with primary hypophysitis. MethodsA total of 753 malignant tumor patients who were hospitalized at Sir Run Run Shaw Hospital School of Medicine, Zhejiang University from January 2019 to November 2022 and received ICIs treatment were retrospectively included. The incidence of endocrine irAEs were statistically analyzed. The clinical characteristics of patients with pituitary irAEs were analyzed and compared with those of patients with primary hypophysitis (n＝18). ResultsAmong the 753 patients treated with ICIs, the majority (742, 98.5%) received PD-1/PD-L1 inhibitors. The incidence of endocrine irAEs was 32.0% (241/753), with primary thyroid dysfunction being most common (212, 28.2%), followed by pituitary dysfunction (35, 4.6%). The median time to onset of pituitary irAEs was 5.8 months, with the majority presenting as secondary hypoadrenocorticism (33, 94.3%). Surgery was a protective factor for preventing pituitary irAEs (P＝0.002), whereas higher body mass index (BMI) and dual ICIs combination therapy were recognized as risk factors (P＜0.05). Compared to patients with primary hypophysitis, patients with pituitary irAEs had a higher proportion of males, lower BMI, lower rates of visual field defects and diabetes insipidus, higher rate of secondary hypoadrenocorticism and lower positive rate on MRI (P＜0.05).ConclusionsMalignant tumor patients treated with ICIs exhibit a relatively high incidence of endocrine irAEs, with thyroid involvement being most common, followed by the pituitary gland. Pituitary irAEs primarily manifest as secondary hypoadrenocorticism, lacking specific clinical symptoms and exhibiting a low positive rate on MRI. These factors contribute to a high risk of misdiagnosis or missed diagnosis, necessitating heightened clinical vigilance. |
| format | Article |
| id | doaj-art-ed6689ec9e7d4cabb84339abd21b4c4f |
| institution | Kabale University |
| issn | 1008-6358 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Shanghai Chinese Clinical Medicine Press Co., Ltd. |
| record_format | Article |
| series | Zhongguo Linchuang Yixue |
| spelling | doaj-art-ed6689ec9e7d4cabb84339abd21b4c4f2025-08-26T01:29:39ZengShanghai Chinese Clinical Medicine Press Co., Ltd.Zhongguo Linchuang Yixue1008-63582025-08-0132453654310.12025/j.issn.1008-6358.2025.2025032320250323Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse eventsYufan ZHENG0Jingjing WANG1Qin YUAN2Fenping ZHENG3Department of Endocrinology, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, ChinaZhejiang Hospital, Phase Ⅰ Clinical Trial Laboratory, Hangzhou 310013, Zhejiang, ChinaDepartment of Endocrinology, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, ChinaDepartment of Endocrinology, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, ChinaObjectiveTo explore the clinical characteristics of immune-related adverse events (irAEs) involving the pituitary gland in malignant tumor patients following the administration of immune checkpoint inhibitors (ICIs), and to compare characteristics of pituitary irAEs with primary hypophysitis. MethodsA total of 753 malignant tumor patients who were hospitalized at Sir Run Run Shaw Hospital School of Medicine, Zhejiang University from January 2019 to November 2022 and received ICIs treatment were retrospectively included. The incidence of endocrine irAEs were statistically analyzed. The clinical characteristics of patients with pituitary irAEs were analyzed and compared with those of patients with primary hypophysitis (n＝18). ResultsAmong the 753 patients treated with ICIs, the majority (742, 98.5%) received PD-1/PD-L1 inhibitors. The incidence of endocrine irAEs was 32.0% (241/753), with primary thyroid dysfunction being most common (212, 28.2%), followed by pituitary dysfunction (35, 4.6%). The median time to onset of pituitary irAEs was 5.8 months, with the majority presenting as secondary hypoadrenocorticism (33, 94.3%). Surgery was a protective factor for preventing pituitary irAEs (P＝0.002), whereas higher body mass index (BMI) and dual ICIs combination therapy were recognized as risk factors (P＜0.05). Compared to patients with primary hypophysitis, patients with pituitary irAEs had a higher proportion of males, lower BMI, lower rates of visual field defects and diabetes insipidus, higher rate of secondary hypoadrenocorticism and lower positive rate on MRI (P＜0.05).ConclusionsMalignant tumor patients treated with ICIs exhibit a relatively high incidence of endocrine irAEs, with thyroid involvement being most common, followed by the pituitary gland. Pituitary irAEs primarily manifest as secondary hypoadrenocorticism, lacking specific clinical symptoms and exhibiting a low positive rate on MRI. These factors contribute to a high risk of misdiagnosis or missed diagnosis, necessitating heightened clinical vigilance.https://www.c-jcm.com/article/doi/10.12025/j.issn.1008-6358.2025.20250323immune checkpoint inhibitorendocrine immune-related adverse eventhypophysitis |
| spellingShingle | Yufan ZHENG Jingjing WANG Qin YUAN Fenping ZHENG Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events Zhongguo Linchuang Yixue immune checkpoint inhibitor endocrine immune-related adverse event hypophysitis |
| title | Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events |
| title_full | Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events |
| title_fullStr | Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events |
| title_full_unstemmed | Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events |
| title_short | Clinical characteristic analysis of immune checkpoint inhibitor-related pituitary adverse events |
| title_sort | clinical characteristic analysis of immune checkpoint inhibitor related pituitary adverse events |
| topic | immune checkpoint inhibitor endocrine immune-related adverse event hypophysitis |
| url | https://www.c-jcm.com/article/doi/10.12025/j.issn.1008-6358.2025.20250323 |
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