Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541 |
Resumo: | Autoimmune hypophysitis has been described in patients on ipilimumab, a humanised monoclonal antibody increasingly used in the treatment of metastatic melanoma. A 67-year-old woman presented with severe fatigue, nausea and headaches following the third dose of ipilimumab, which was being given as treatment for metastatic melanoma (four administrations at three-weekly intervals). Hormonal evaluation confirmed hypocortisolism, with low gonadotrophins and a low thyroid-stimulating hormone with normal free T4 (she was on long-standing levothyroxine because of past surgery for a multinodular goitre). Magnetic resonance imaging scanningrevealed pituitary enlargement compatible with autoimmune hypophysitis. She was commenced on replacement with hydrocortisone with significant improvement of her symptoms. The enlarged pituitary was reduced in size 4 months later. The patient is currently asymptomatic on glucocorticoid and levothyroxine replacement. This case highlights relevant clinical, diagnostic and management aspects of ipilimumab-induced autoimmune hypophysitis, and emphasises the need for increasing awareness for potential side-effects of these new immunomodulatory therapies, including autoimmune hypophysitis. |
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Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical CaseHipofisite Induzida por Ipilimumab: Desafios Diagnósticos e TerapêuticosAntibodiesMonoclonalInflammation/chemically inducedIpilimumabPituitary Diseases/chemically induced.Anticorpos MonoclonaisDoenças da Hipófise/ induzido quimicamenteInflamação/induzido quimicamenteIpilimumab.Autoimmune hypophysitis has been described in patients on ipilimumab, a humanised monoclonal antibody increasingly used in the treatment of metastatic melanoma. A 67-year-old woman presented with severe fatigue, nausea and headaches following the third dose of ipilimumab, which was being given as treatment for metastatic melanoma (four administrations at three-weekly intervals). Hormonal evaluation confirmed hypocortisolism, with low gonadotrophins and a low thyroid-stimulating hormone with normal free T4 (she was on long-standing levothyroxine because of past surgery for a multinodular goitre). Magnetic resonance imaging scanningrevealed pituitary enlargement compatible with autoimmune hypophysitis. She was commenced on replacement with hydrocortisone with significant improvement of her symptoms. The enlarged pituitary was reduced in size 4 months later. The patient is currently asymptomatic on glucocorticoid and levothyroxine replacement. This case highlights relevant clinical, diagnostic and management aspects of ipilimumab-induced autoimmune hypophysitis, and emphasises the need for increasing awareness for potential side-effects of these new immunomodulatory therapies, including autoimmune hypophysitis.A hipofisite autoimune tem sido reportada em doentes sob ipilimumab, um anticorpo monoclonal humanizado usado no tratamento do melanoma metastático. Apresenta-se o caso de uma doente do sexo feminino, 67 anos, com um quadro de fadiga, náuseas e cefaleias após a terceira dose de ipilimumab para tratamento de melanoma metastático (quatro administrações com intervalos de três semanas). A avaliação hormonal confirmou hipocortisolismo, gonadotrofinas baixas e hormona estimulante da tiróide com T4 livre normal (sob terapêutica com levotiroxina devido a cirurgia tiroideia prévia). A ressonância mangnética revelou aumento do volume hipofisário compatível com hipofisite autoimune. Iniciou-se terapêutica substitutiva com hidrocortisona oral, com melhoria sintomática. Quatro meses depois verificou-se redução do volume da hipófise. A doente está atualmente assintomática sob terapêutica com glucocorticóides e levotiroxina. Este caso ilustra aspetos clínicos, diagnósticos e terapêuticos da hipofisite autoimune induzida por ipilimumab, enfatizando a necessidade de alerta para os potenciais efeitos adversos das novas terapêuticas imunomoduladoras, entre os quais a hipofisite autoimune.Ordem dos Médicos2015-10-07info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfimage/tiffimage/tiffhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541oai:ojs.www.actamedicaportuguesa.com:article/6541Acta Médica Portuguesa; Vol. 28 No. 6 (2015): November-December; 775-779Acta Médica Portuguesa; Vol. 28 N.º 6 (2015): Novembro-Dezembro; 775-7791646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/4560https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7643https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7891https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7982https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/8040https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/8041Marques, PedroGrossman, Ashleyinfo:eu-repo/semantics/openAccess2022-12-20T11:04:53Zoai:ojs.www.actamedicaportuguesa.com:article/6541Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:19.706248Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case Hipofisite Induzida por Ipilimumab: Desafios Diagnósticos e Terapêuticos |
title |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
spellingShingle |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case Marques, Pedro Antibodies Monoclonal Inflammation/chemically induced Ipilimumab Pituitary Diseases/chemically induced. Anticorpos Monoclonais Doenças da Hipófise/ induzido quimicamente Inflamação/induzido quimicamente Ipilimumab. |
title_short |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
title_full |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
title_fullStr |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
title_full_unstemmed |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
title_sort |
Ipilimumab-Induced Autoimmune Hypophysitis: Diagnostic and Management Challenges Illustrated by a Clinical Case |
author |
Marques, Pedro |
author_facet |
Marques, Pedro Grossman, Ashley |
author_role |
author |
author2 |
Grossman, Ashley |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Marques, Pedro Grossman, Ashley |
dc.subject.por.fl_str_mv |
Antibodies Monoclonal Inflammation/chemically induced Ipilimumab Pituitary Diseases/chemically induced. Anticorpos Monoclonais Doenças da Hipófise/ induzido quimicamente Inflamação/induzido quimicamente Ipilimumab. |
topic |
Antibodies Monoclonal Inflammation/chemically induced Ipilimumab Pituitary Diseases/chemically induced. Anticorpos Monoclonais Doenças da Hipófise/ induzido quimicamente Inflamação/induzido quimicamente Ipilimumab. |
description |
Autoimmune hypophysitis has been described in patients on ipilimumab, a humanised monoclonal antibody increasingly used in the treatment of metastatic melanoma. A 67-year-old woman presented with severe fatigue, nausea and headaches following the third dose of ipilimumab, which was being given as treatment for metastatic melanoma (four administrations at three-weekly intervals). Hormonal evaluation confirmed hypocortisolism, with low gonadotrophins and a low thyroid-stimulating hormone with normal free T4 (she was on long-standing levothyroxine because of past surgery for a multinodular goitre). Magnetic resonance imaging scanningrevealed pituitary enlargement compatible with autoimmune hypophysitis. She was commenced on replacement with hydrocortisone with significant improvement of her symptoms. The enlarged pituitary was reduced in size 4 months later. The patient is currently asymptomatic on glucocorticoid and levothyroxine replacement. This case highlights relevant clinical, diagnostic and management aspects of ipilimumab-induced autoimmune hypophysitis, and emphasises the need for increasing awareness for potential side-effects of these new immunomodulatory therapies, including autoimmune hypophysitis. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-10-07 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541 oai:ojs.www.actamedicaportuguesa.com:article/6541 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/6541 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/4560 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7643 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7891 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/7982 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/8040 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6541/8041 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf application/pdf application/pdf application/pdf image/tiff image/tiff |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
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Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 28 No. 6 (2015): November-December; 775-779 Acta Médica Portuguesa; Vol. 28 N.º 6 (2015): Novembro-Dezembro; 775-779 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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