Poster Presentation The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Immunomodulation: Changing epidemiology of hypophysitis – Case reports (#285)

Divya Srivastava 1 2 , Beverly Rodrigues 1 , Vasant Shenoy 1 2 , Zulfiquer Otty 3 , Kunwarjit S Sangla 2
  1. School of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
  2. Department of Diabetes and Endocrinology, The Townsville Hospital, Douglas, QLD, Australia
  3. Department of Oncology, The Townsville Hospital, Douglas, QLD, Australia

Autoimmune hypophysitis has been an uncommon cause of pituitary dysfunction [1]. However the increasing use of immunomodulation in cancer therapy has resulted in a rise and changing demographic of immune mediated endocrinopathies including hypophysitis [2,3]. We present two such cases of Ipilimumab (Anti CTLA4 checkpoint inhibitor) associated hypophysitis.

Both cases had metastatic melanoma, but disease presentation and burden differed. Whilst both patients also had generalised lethargy, their endocrine manifestations differed from secondary hypothyroidism only in one case and dual pituitary axes involvement in the other. Both had pituitary masses on imaging and whilst one received intravenous steroids, the other was managed on an outpatient basis only with oral steroids. Pituitary masses resolved in both cases, but one was weaned off thyroxine whilst the other required ongoing replacement therapy and their progression of underlying disease also differed.

Ipilimumab is proven to improve survival in patients of metastatic melanoma, but is associated with the risk of autoimmune endocrinopathies [2,3], which if diagnosed early can prevent significant morbidity & mortality. It is imperative that we as clinicians recognise and differentiate this disease spectrum from metastatic disease and identify optimal treatment regimens to enable the best possible outcomes for our patients.

  1. Patrizio Caturegli, Craig Newschaffer, Alessandro Olivi, Martin G. Pomper, Peter C. Burger, and Noel R. Rose: Autoimmune Hypophysitis .Endocrine Reviews, 2005. 26(5): p. 599-614.
  2. Corsello SM, Barnabei A, Marchetti P, De Vecchis L, Salvatori R, Torino F. Endocrine side effects induced by immune checkpoint inhibitors. The Journal of clinical endocrinology and metabolism. 2013 Apr;98(4):1361-75. PubMed PMID: 23471977.
  3. Torino F, Barnabei A, De Vecchis L, Salvatori R, Corsello SM. Hypophysitis induced by monoclonal antibodies to cytotoxic T lymphocyte antigen 4: challenges from a new cause of a rare disease. The oncologist. 2012;17(4):525-35. PubMed PMID: 22477725. Pubmed Central PMCID: 3336822.