Health

Is a biopsy necessary to distinguish immunotherapy associated hypophysitis from progressive metastatic cancer? No, a biopsy is not recommended for immunotherapy-associated hypophysitis if the condition is temporally associated with the recent initiation of therapy (i.e., after 3–4 cycles). In addition, unlike IH, metastatic cancer in the pituitary gland/stalk would more likely present with DI.

What is the clinical presentation for ipilimumab-induced hypophysitis (IH)? The diagnosis of IH is presumptive and based on the presence of new-onset hypopituitarism in medically-treated patients, and without an alternative etiology. It is most commonly observed in older males (mean age 55 years) and after ≈ 3 months (or 3–4 cycles) of treatment. Clinically, patients …

Symptoms of ipilimumab induced hypophysitis Read More »

What immunotherapeutic agents may cause hypophysitis/pituitary stalk inflammation? Hypophysitis is the most common immune-related adverse reaction (IRAE) associated with the immunotherapeutic agents/immune checkpoint inhibitors used to treat melanoma and lung cancer. The agents most commonly implicated are ipilimumab, an IgG1 antibody directed against cytotoxic T-lymphocyte antigen 4; pembrolizumab and nivolumab, IgG4 antibodies directed against programmed …

What immunotherapeutic agents may cause hypophysitis Read More »

What are the natural history and treatment options for primary hypophysitis? The natural history of hypophysitis typically involves progressive pituitary inflammation, followed by atrophy, fibrosis, and hypopituitarism. Partial spontaneous recovery of both anterior and posterior pituitary function can occur, but persistent hypopituitarism is more common. In cases of suspected, noninfectious hypophysitis (primary/secondary) and neurosarcoidosis, particularly …

Treatment options for primary hypophysitis Read More »

How useful are serum ACE, IgG4, and antipituitary antibody (APA) levels for diagnosing hypophysitis? Sources 1.Urushida Y, Ishikawa D, Yanaizumi M, Nakamura T, Amari M, Kawarabayashi T, Tosaka M, Ikeda Y, Takatama M, Shoji M. IgG4-related hypothalamo-hypophysitis. eNeurologicalSci. 2021 Jul 28;24:100362. doi: 10.1016/j.ensci.2021.100362. PMID: 34466672; PMCID: PMC8385281.https://pmc.ncbi.nlm.nih.gov/articles/PMC8385281/

How should patients with pituitary stalk lesions be evaluated? A comprehensive history and physical examination should be performed, including medication review, travel history, evaluation for constitutional symptoms, and examination for possible extrapituitary manifestations of systemic disease. The following biochemical evaluation, as guided by clinical context, are also recommended: 1. Measurement of anterior pituitary hormones and …

How to evaluate pituitary stalk lesions Read More »

What imaging is helpful in evaluating pituitary stalk lesions? Ideally, high-resolution, thin-cut, gadolinium-enhanced, pituitary-dedicated magnetic resonance imaging (MRI) should be performed to best characterize the pituitary/stalk lesions and their proximity to adjacent structures. On MRI, the normal posterior pituitary gland is hyperintense/‘bright spot’ on T1-weighted, non–contrast-enhanced images, because of the neurosecretory granules. The presence of …

What imaging is helpful in evaluating pituitary stalk lesions Read More »