Abstract：
OBJECTIVE: We aimed to elucidate the clinical features of pituitary immune-related adverse events (irAEs) induced by PD-1 inhibitors in a Chinese cohort and the previous literatures.
UNASSIGNED: We retrospectively analysed the clinical manifestations, laboratory examination findings, imaging features and treatments of 14 patients with pituitary irAEs caused by PD-1 inhibitors in our cohort. In addition, we searched PubMed for all English articles on pituitary irAEs induced by PD-1 inhibitors published from 1950 to 2023. A total of 47 articles were included, and the clinical characteristics of 94 patients with pituitary irAEs induced by PD-1 inhibitors in these literatures were compared to the characteristics of our cohort.
RESULTS: Among the 14 patients in our cohort with pituitary irAEs induced by PD-1 inhibitors, 12 patients (85.71%, 12/14) exhibited isolated ACTH deficiency (IAD), 100.0% (14/14) of the central adrenocortical insufficiency, and 2 patients showed more than one hypothalamic-pituitary axis injury (14.29%, 2/14). Pituitary magnetic resonance imaging in all the 14 patients showed no pituitary enlargement. In previous studies we reviewed, 82.98% of the total (78/94) presented with pituitary irAEs as IAD, 100.0% (94/94) of the central adrenocortical insufficiency, and 78.33% of the patients showed no abnormality of the pituitary gland (47/60). The pituitary irAEs caused by PD-1 inhibitors did not involve typical manifestations of hypophysitis, such as pituitary enlargement, headache, visual field defects, and multiple pituitary function impairments in our cohort and the previous literatures.
CONCLUSIONS: In our study, pituitary immune-related adverse reactions induced by PD-1 inhibitors mainly manifested isolated ACTH deficiency rather than hypophysitis.
UNASSIGNED: We retrospectively analysed the clinical manifestations, laboratory examination findings, imaging features and treatments of 14 patients with pituitary irAEs caused by PD-1 inhibitors in our cohort. In addition, we searched PubMed for all English articles on pituitary irAEs induced by PD-1 inhibitors published from 1950 to 2023. A total of 47 articles were included, and the clinical characteristics of 94 patients with pituitary irAEs induced by PD-1 inhibitors in these literatures were compared to the characteristics of our cohort.
RESULTS: Among the 14 patients in our cohort with pituitary irAEs induced by PD-1 inhibitors, 12 patients (85.71%, 12/14) exhibited isolated ACTH deficiency (IAD), 100.0% (14/14) of the central adrenocortical insufficiency, and 2 patients showed more than one hypothalamic-pituitary axis injury (14.29%, 2/14). Pituitary magnetic resonance imaging in all the 14 patients showed no pituitary enlargement. In previous studies we reviewed, 82.98% of the total (78/94) presented with pituitary irAEs as IAD, 100.0% (94/94) of the central adrenocortical insufficiency, and 78.33% of the patients showed no abnormality of the pituitary gland (47/60). The pituitary irAEs caused by PD-1 inhibitors did not involve typical manifestations of hypophysitis, such as pituitary enlargement, headache, visual field defects, and multiple pituitary function impairments in our cohort and the previous literatures.
CONCLUSIONS: In our study, pituitary immune-related adverse reactions induced by PD-1 inhibitors mainly manifested isolated ACTH deficiency rather than hypophysitis.
摘要：
目的：我们的目的是阐明PD-1抑制剂诱导的垂体免疫相关不良事件（irAEs）的临床特征。
■我们回顾性分析了临床表现，实验室检查结果，我们队列中14例PD-1抑制剂引起的垂体irAE患者的影像学特征和治疗。此外,我们检索了PubMed发表于1950年至2023年的所有有关PD-1抑制剂诱导垂体irAE的英文文章.共收录47篇文章,并将这些文献中94例PD-1抑制剂诱导的垂体irAE患者的临床特征与我们的队列特征进行了比较。
结果：在我们队列中的14例患者中，PD-1抑制剂诱导的垂体irAE，12例(85.71%,12/14）表现出孤立的ACTH缺乏症（IAD），100.0%（14/14）的中央性肾上腺皮质功能不全，2例患者出现一次以上的下丘脑-垂体轴损伤（14.29%，2/14).所有14例患者的垂体磁共振成像均未显示垂体肿大。在我们回顾的先前研究中，总的82.98%(78/94)表现为脑垂体IAD，100.0%（94/94）的中央性肾上腺皮质功能不全，78.33%的患者垂体无异常(47/60)。由PD-1抑制剂引起的垂体irAE不涉及垂体炎的典型表现。比如垂体肿大，头痛,视野缺陷,在我们的队列和以前的文献中，多发性垂体功能障碍。
结论：在我们的研究中，PD-1抑制剂引起的垂体免疫相关不良反应主要表现为单纯的ACTH缺乏而非垂体炎。
■我们回顾性分析了临床表现，实验室检查结果，我们队列中14例PD-1抑制剂引起的垂体irAE患者的影像学特征和治疗。此外,我们检索了PubMed发表于1950年至2023年的所有有关PD-1抑制剂诱导垂体irAE的英文文章.共收录47篇文章,并将这些文献中94例PD-1抑制剂诱导的垂体irAE患者的临床特征与我们的队列特征进行了比较。
结果：在我们队列中的14例患者中，PD-1抑制剂诱导的垂体irAE，12例(85.71%,12/14）表现出孤立的ACTH缺乏症（IAD），100.0%（14/14）的中央性肾上腺皮质功能不全，2例患者出现一次以上的下丘脑-垂体轴损伤（14.29%，2/14).所有14例患者的垂体磁共振成像均未显示垂体肿大。在我们回顾的先前研究中，总的82.98%(78/94)表现为脑垂体IAD，100.0%（94/94）的中央性肾上腺皮质功能不全，78.33%的患者垂体无异常(47/60)。由PD-1抑制剂引起的垂体irAE不涉及垂体炎的典型表现。比如垂体肿大，头痛,视野缺陷,在我们的队列和以前的文献中，多发性垂体功能障碍。
结论：在我们的研究中，PD-1抑制剂引起的垂体免疫相关不良反应主要表现为单纯的ACTH缺乏而非垂体炎。
