The American Society of Clinical Oncology (ASCO) has reviewed complications associated with immune checkpoint inhibitor therapy.
Patient selection: pituitary toxicity and hypophysitis following therapy with an immune checkpoint inhibitor
Parameters:
(1) signs and symptoms
(2) functional status
Signs and Symptoms
Functional Status
Grade
none or mild
able to perform ADL
G1
moderate
able to perform ADL
G2
severe
unable to perform ADL
G3
life-threatening
unable to perform ADL
G4
Laboratory features:
(1) low serum cortisol in morning AND low serum ACTH
(2) low serum TSH AND low serum free T4
The diagnosis requires exclusion of other causes of damage to the pituitary and hypophysis such as metastatic cancer. Corticosteroid therapy may suppress ACTH for a significant period after discontinuation.
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