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Jeremy Turner, Neil Gittoes, Peter Selby and the Society for Endocrinology Clinical Committee

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Jennifer Walsh, Neil Gittoes, Peter Selby and the Society for Endocrinology Clinical Committee

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Stephen Ball, Julian Barth, Miles Levy and the Society for Endocrinology Clinical Committee

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Jeremy Turner, Neil Gittoes, Peter Selby and the Society for Endocrinology Clinical Committee

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C E Higham, A Olsson-Brown, P Carroll, T Cooksley, J Larkin, P Lorigan, D Morganstein, P J Trainer and the Society for Endocrinology Clinical Committee

Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3–4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1–2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed.

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Stephanie E Baldeweg, Mark Vanderpump, Will Drake, Narendra Reddy, Andrew Markey, Gordon T Plant, Michael Powell, Saurabh Sinha, John Wass and the Society for Endocrinology Clinical Committee

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S E Baldeweg, S Ball, A Brooke, H K Gleeson, M J Levy, M Prentice, J Wass and the Society for Endocrinology Clinical Committee

Cranial diabetes insipidus (CDI) is a treatable chronic condition that can potentially develop into a life-threatening medical emergency. CDI is due to the relative or absolute lack of the posterior pituitary hormone vasopressin (AVP), also known as anti-diuretic hormone. AVP deficiency results in uncontrolled diuresis. Complete deficiency can lead to polyuria exceeding 10 L/24 h. Given a functioning thirst mechanism and free access to water, patients with CDI can normally maintain adequate fluid balance through increased drinking. Desmopressin (DDAVP, a synthetic AVP analogue) reduces uncontrolled water excretion in CDI and is commonly used in treatment. Critically, loss of thirst perception (through primary pathology or reduced consciousness) or limited access to water (through non-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients with CDI. These adverse outcomes and deaths have occurred through a combination of lack of knowledge and treatment failures by health professionals. Here, with our guideline, we recommend treatment pathways for patients with known CDI admitted to hospital. Following these guidelines is essential for the safe management of patients with CDI.