Patients receiving drugs in the novel class of cancer therapeutics called immune checkpoint inhibitors Monoclonal antibodies Systemic cancer therapy includes chemotherapy (ie, conventional or cytotoxic chemotherapy), hormone therapy, targeted therapy, and immune therapy (see also Overview of Cancer Therapy). The number... read more , have an increased risk for development of autoimmune disorders Autoimmune Disorders In autoimmune disorders, the immune system produces antibodies to an endogenous antigen (autoantigen). The following hypersensitivity reactions may be involved: Type II: Antibody-coated cells... read more , including endocrine disorders. Hypophysitis, autoimmune thyroid disease (both hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms are many and include tachycardia, fatigue, weight loss, nervousness, and tremor... read more and hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. It is diagnosed by clinical features such as a typical facial appearance, hoarse slow speech, and dry skin and by low levels of thyroid hormones... read more ), type 1 diabetes Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , and primary adrenal insufficiency Addison Disease Addison disease is an insidious, usually progressive hypofunctioning of the adrenal cortex. It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis... read more have been reported (1, 2 General references Patients receiving drugs in the novel class of cancer therapeutics called immune checkpoint inhibitors, have an increased risk for development of autoimmune disorders, including endocrine disorders... read more ).
Diagnosis is by measurement of levels of glucose, electrolytes, and hormones as clinically indicated.
Treatment is replacement of hormones documented to be deficient. These might include thyroid hormone, insulin, or glucocorticoids.
1. Ruggeri RM, Campennì A, Giuffrida G, et al: Endocrine and metabolic adverse effects of immune checkpoint inhibitors: an overview (what endocrinologists should know). J Endocrinol Invest Nov. 23, 2018. https://doi.org/10.1007/s40618-018-0984-z
2. Chang L-S, Barroso-Sousa R, Tolaney SM, et al: Endocrine toxicity of cancer immunotherapy targeting immune checkpoints. Endocr Rev 40(1):17–65, 2019. doi: 10.1210/er.2018-00006