Approach to the Patient With Immune Checkpoint Inhibitor-Associated Endocrine Dysfunction

Immune checkpoint inhibitors (ICI) are cancer therapies that are approved for use in at least 19 different cancers. They function by stimulating immune cell responses against cancer, and their toxicities comprise a host of autoinflammatory syndromes that may impact any organ system. Endocrine toxicities occur in as high as 25% to 50% of ICI recipients, depending on the treatment regimen used. These toxicities vary in severity from mild, asymptomatic cases of subclinical hypothyroidism to severe, fatal cases of adrenal crisis, thyroid dysfunction, or diabetic ketoacidosis. Thus, timely recognition and treatment is critical. Herein, we present clinical cases of ICI-induced thyroid dysfunction, hypophysitis, and insulin-dependent diabetes mellitus. We use these cases to discuss the screening, diagnosis, and management of ICI-associated endocrine dysfunction.

Automated summary

Immune checkpoint inhibitors (ICI) are approved for use in various cancers and can stimulate immune cell responses against cancer. However, they can also cause toxicities in any organ system, with endocrine toxicities being common. These toxicities can range from mild cases of subclinical hypothyroidism to severe cases of adrenal crisis, thyroid dysfunction, or diabetic ketoacidosis. Timely recognition and treatment are crucial for managing ICI-associated endocrine dysfunction.