Emergency presentations of immune checkpoint inhibitor-related endocrinopathies
AffiliationThe Christie Hospital, Manchester, United Kingdom.
MetadataShow full item record
AbstractBackground: Immune checkpoint inhibitors (ICI) are an important component of anticancer treatment, with indications across an increasing range of oncological diagnoses. ICIs are associated with a range of immune-mediated toxicities. Immune-related endocrinopathies pose a distinct challenge, given the nonspecific symptom profile and potentially life-threatening sequelae if not recognized. Objectives: To determine the frequency and clinical presentations of immune-mediated endocrinopathies in patients treated with ICIs presenting as emergencies. Methods: A prospective observational cohort study was undertaken at a specialist oncology hospital in North West England from May 20, 2018 to May 19, 2020. Within the hospital, the Oncology Assessment Unit (OAU) acts as the receiving unit in which assessments are undertaken of all emergency presentations. All patients treated with ICIs presenting to the OAU were included. The primary outcome was diagnosis of an immune-mediated endocrinopathy. Length of inpatient stay, and 7- and 30-day mortality rates were examined. Results: During the study period, 684 patients treated with ICIs presented to the OAU. Twenty-four (3.5%) patients had an acute immune-mediated endocrinopathy, of which 17 had hypophysitis, 4 diabetes mellitus, 2 thyrotoxicosis, and 1 adrenalitis. Median length of stay for patients with hypophysitis was 1 day. No patient with an immune-mediated endocrinopathy died within 30 days of presentation. Conclusions: Presentations to emergency settings with acute immune-mediated endocrinopathies are rare. Early recognition of immune-mediated toxicities is important, and particularly pertinent in ICI-related endocrinopathies, where even in life-threatening cases, the presentation can be vague and nonspecific.
CitationKnight T, Cooksley T. Emergency Presentations of Immune Checkpoint Inhibitor-Related Endocrinopathies. J Emerg Med. 2021.
JournalJournal of Emergency Medicine
- American Association of Clinical Endocrinology Disease State Clinical Review: Evaluation and Management of Immune Checkpoint Inhibitor-Mediated Endocrinopathies: A Practical Case-Based Clinical Approach.
- Authors: Yuen KCJ, Samson SL, Bancos I, Gosmanov AR, Jasim S, Fecher LA, Weber JS
- Issue date: 2022 Jul
- Emergency presentations in patients treated with immune checkpoint inhibitors.
- Authors: Cooksley T, Gupta A, Al-Sayed T, Lorigan P
- Issue date: 2020 May
- The spectrum, incidence, kinetics and management of endocrinopathies with immune checkpoint inhibitors for metastatic melanoma.
- Authors: Scott ES, Long GV, Guminski A, Clifton-Bligh RJ, Menzies AM, Tsang VH
- Issue date: 2018 Feb
- Mapping endocrine toxicity spectrum of immune checkpoint inhibitors: a disproportionality analysis using the WHO adverse drug reaction database, VigiBase.
- Authors: Bai X, Lin X, Zheng K, Chen X, Wu X, Huang Y, Zhuang Y
- Issue date: 2020 Sep
- Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities.
- Authors: Cooksley T, Girotra M, Ginex P, Gordon RA, Anderson R, Blidner A, Choi J, Dougan M, Glezerman I, Gupta D, Johnson D, Shannon VR, Suarez-Almazor M, Rapoport BL
- Issue date: 2020 Dec