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Aim: To define functional and anatomical pituitary disease following ICI therapy and describe any change in pituitary function with time.
Methods: Retrospective observational audit of patients on ICI therapy in our centre between 2013 and 2023. We reviewed all patients on ICI therapy under the oncology department at University Hospital Plymouth, and identified individuals referred to endocrinology with suspected adrenal insufficiency. Patients were established on adrenal steroid replacement and subsequently underwent formal pituitary testing. Pituitary disease was evidenced by low ACTH, other pituitary dysfunction and/or abnormalities on pituitary imaging.
Results: 954 patients received ICI therapy during the study period, and 37 developed HPA axis dysfunction. Median interval of onset of symptoms was 4 months. There was no recovery in cortisol or ACTH for any individual on repeated testing. Other permanent anterior pituitary hormone defects were unusual. Hypophysitis associated with immunotherapy appears to specifically target corticotrophs with no evidence of recovery. There was a specific abnormality seen in MRI scans of 7 of 27 patients who had scans, appearing to be a particular feature of immune mediated hypophysitis. These were confined to the anterior aspect of the pituitary as striations and were not visible on any scans performed more than three months after disease onset.
Conclusion: These data show that immune related (IR) hypophysitis is a common complication of immune checkpoint inhibitor therapy. This may result in an imaging abnormality within the areas of the pituitary richest in corticotrophs. The endocrine consequence of this is a permanent defect in ACTH and therefore cortisol production.
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Introduction Cushing’s disease (CD) is a state of cortisol excess, caused by an ACTH-secreting pituitary adenoma. Although a rare disease with an annual incidence of 1.5 patients/million ( 1 ), it is associated with significant morbidity and
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The University of Liverpool, Brownlow Hill, Liverpool, UK
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screening. CTCAE grade 1–2. Other important considerations; hypophysitis and maintenance glucocorticoid therapy. Management of a life-threateningly unwell patient (CTCAE grade 3–4) Cortisol Features of acute cortisol
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Department of Neuroscience, Georgetown University, Washington, District of Columbia, USA
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glucocorticoid levels and high anxiety. Despite this, individuals with PTSD also have higher levels of CRH in the cerebral spinal fluid ( 27 ) and appear to have similar cortisol reactivity to individuals without the disorder ( 28 ). Based on these findings, it
Department of Neuroscience DNS, University of Padova, Padova, Italy
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Nuclear Medicine Unit, Department of Medicine – DIMED, University-Hospital of Padova, Padova, Italy
Padova Neuroscience Center PNC, University of Padova, Padova, Italy
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Department of Mathematics ‘Tullio Levi-Civita’ DM, University of Padova, Padova, Italy
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Introduction Cushing’s syndrome (CS), characterized by excessive endogenous cortisol secretion, is in most cases ACTH-dependent. Corticotropin (ACTH) secretion arises from a pituitary adenoma (Cushing’s disease) or, less frequently, from a non
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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Introduction Acute adrenal insufficiency , also termed adrenal crisis , is a life-threatening endocrine emergency brought about by a lack of production of the adrenal hormone cortisol, the major glucocorticoid. Identifying patients at risk
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, the rate-limiting step in adrenal steroidogenesis, is also upregulated by ACTH-induced MC2R activation ( 43 ). Likewise, the final enzyme for cortisol synthesis, 11-β-hydroxylase, which converts 11-deoxycortisol into cortisol is upregulated upon ACTH
Department of Neurosurgery, Rui-Jin Lu-Wan Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Department of Neurosurgery, Rui-Jin Lu-Wan Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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College of Information Technology and Engineering, Chengdu University, Chengdu, China
College of Computer Science, Sichuan Normal University, Chengdu, Sichuan, China
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-h urinary free cortisol (UFC) level, bilateral petrosal sinus sampling, absence of a blunted circadian rhythm of cortisol secretion, and other clinical features ( 18 ). CD remission was confirmed in all remitted CD patients by normal UFC after
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intake. However, our cases were tolerating feeds during their illness (barring case 1 during early phase of illness). We postulate that this phenomenon may involve cortisol-driven effects on 1,25(OH) 2 -vitamin D. It is recognised that the stress of
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Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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which treatment with supraphysiological doses of exogenous steroid is required. The aim of glucocorticoid replacement therapy in adrenal failure is to reverse the deficiency using only physiological doses of steroids. Reproducing the diurnal cortisol