September 7, 2015
A 52-year-old man with history of melanoma, presenting with headaches, visual symptoms, and panhypopituitarism
Ipilimumab-Induced Hypophysitis
- Background: Ipilimumab is a human monoclonal antibody that has been shown to overcome the suppressive effects of cytotoxic T-lymphocyte antigen-4 expression, thereby enhancing the immune response against cancer cells. Immune-related adverse events, including hypophysitis, may occur in some patients as a consequence of increased T cell activation.
- Clinical Presentation: The most common presenting symptoms are headaches and multiple endocrine deficiencies with partial or total hypopituitarism.
- Key Diagnostic Features: : Enlarged, usually homogenously enhancing pituitary with variable involvement of the infundibulum. Diffuse enlargement of the pituitary gland in patients treated with ipilimumab is considered a sensitive and specific finding of drug-induced hypophysitis.
- DDx:
- Metastasis
- Pituitary hyperplasia
- Adenoma
- Treatment: Cessation of drug, corticosteroids, and hormone replacement
