Is a biopsy necessary to distinguish immunotherapy associated hypophysitis from progressive metastatic cancer

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.

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