Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management

Immune checkpoint inhibitors (ICPis) have proven extremely efficacious in cancer therapy but also lead to a plethora of immune-related adverse events (irAEs). The endocrine irAEs are not only quite common but also may pose a challenge to the clinician while managing a patient with cancer treated with ICPis. The clinical features of endocrine dysfunction are usually nonspecific and may overlap with concurrent illnesses, underlying the importance of accurate hormone testing and efforts toward case-finding. The management of endocrine irAEs is unique in the focus being on hormone replacement rather than curtailing the autoimmune process. Although the management of thyroid irAEs appears straightforward, adrenal insufficiency and insulin-dependent diabetes can be life-threatening if not promptly recognized and treated. This clinical review synthesizes the studies to provide pearls and pitfalls in the evaluation and management of endocrine irAEs with specific reference to guidelines from oncologic societies.

Automated summary

Immune checkpoint inhibitors (ICPis) have shown great efficacy in cancer therapy, but they also come with a variety of immune-related adverse events (irAEs), including endocrine irAEs. The clinical features of endocrine dysfunction are nonspecific and accurate hormone testing is crucial for diagnosis. Management of endocrine irAEs focuses on hormone replacement rather than suppressing the autoimmune process. Prompt recognition and treatment are essential for potentially life-threatening irAEs such as adrenal insufficiency and insulin-dependent diabetes. This clinical review provides pearls and pitfalls in the evaluation and management of endocrine irAEs, with reference to guidelines from oncologic societies.