Immune checkpoint inhibitor related hypophysitis: diagnostic criteria and recovery patterns.
Immune checkpoint inhibitor related hypophysitis: diagnostic criteria and recovery patterns.
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DOI：
10.1530/erc-20-0513
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发表时间：
2021-06-02
影响因子：
3.9
通讯作者：
Dadu R
中科院分区：
文献类型：
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作者：
Nguyen H;Shah K;Waguespack SG;Hu MI;Habra MA;Cabanillas ME;Busaidy NL;Bassett R;Zhou S;Iyer PC;Simmons G;Kaya D;Pitteloud M;Subudhi SK;Diab A;Dadu R
有关免疫检查点抑制物(ICI)相关性脑垂体炎(IRH)的诊断、自然病程和治疗的数据有限。我们建议这项研究验证诊断标准，描述特征和激素恢复，并调查与IRH发生和恢复相关的因素。对德克萨斯大学安德森癌症中心2003年5月5日至2017年8月8日的疑似IRH患者进行了一项回顾性研究。IRH定义为：(1)ACTH或TSH缺乏伴MRI改变或(2)ACTH和TSH缺乏伴头痛/乏力，而MRI未见。我们发现，在83名患者的中位随访时间为1.75年(范围0.6-3)中，最初评估时使用的建议标准准确地确定了61/62(98%)IRH病例。在脑出血组(n =62)，最常见的临床表现为头痛(60%)、乏力(66%)、中枢性甲状腺功能减退(94%)、中枢性肾上腺功能不全(69%)和核磁共振改变(77%)。与非ipilimumab(Ipi)方案相比，ipi与脑出血的发生有更强的相关性(P =0.004)，并且发生脑出血的时间更短(P <；0.01)。甲状腺、性腺和肾上腺轴恢复分别为24%、58%和0%。大剂量类固醇(HDS)或ICI的停止与激素恢复无关。在非再出血组(n =19)，1例单纯中枢性甲状腺功能减退，6例单纯中枢性肾上腺功能不全。在最后一次随访时，所有人都继续接受激素治疗。我们建议对IRH进行严格的定义，以确定绝大多数患者的身份。停用HDS和ICI并不总是有益的。需要进行长期跟踪以评估复苏情况。
Data on the diagnosis, natural course and management of immune checkpoint inhibitor (ICI)-related hypophysitis (irH) are limited. We propose this study to validate the diagnostic criteria, describe characteristics and hormonal recovery and investigate factors associated with the occurrence and recovery of irH. A retrospective study including patients with suspected irH at the University of Texas MD Anderson Cancer Center from 5/2003 to 8/2017 was conducted. IrH was defined as: (1) ACTH or TSH deficiency plus MRI changes or (2) ACTH and TSH deficiencies plus headache/fatigue in the absence of MRI findings. We found that of 83 patients followed for a median of 1.75 years (range 0.6–3), the proposed criteria used at initial evaluation accurately identified 61/62 (98%) irH cases. In the irH group (n = 62), the most common presentation was headache (60%), fatigue (66%), central hypothyroidism (94%), central adrenal insufficiency (69%) and MRI changes (77%). Compared with non-ipilimumab (ipi) regimens, ipi has a stronger association with irH occurrence (P = 0.004) and a shorter time to irH development (P < 0.01). Thyroid, gonadal and adrenal axis recovery occurred in 24, 58 and 0% patients, respectively. High-dose steroids (HDS) or ICI discontinuation was not associated with hormonal recovery. In the non-irH group (n = 19), one patient had isolated central hypothyroidism and six had isolated central adrenal insufficiency. All remained on hormone therapy at the last follow-up. We propose a strict definition of irH that identifies the vast majority of patients. HDS and ICI discontinuation is not always beneficial. Long-term follow-up to assess recovery is needed.