Diagnostic criteria and management recommendations for immune related endocrinopathies following immune checkpoint inhibitor therapy for cancer

Abstract

Checkpoint inhibitors are now widely used in the management of many cancers. Endocrine toxicity are amongst the most common side effects. These endocrinopathies differ form from most offer other immune related toxicities, in frequently being irreversible, but and rarely requiring cessation of checkpoint inhibitor therapy. This review covers considers an approach to the presentation and diagnosis and presentation of these endocrinopathies, comparing to classical endocrine diagnosis, making recommendations for classification and treatment based on fundamental endocrine principles suggesting improvements to classification and treatment based on fundamental endocrine principles. These will help to align management with other similar endocrine conditions and standardise the diagnosis and reporting of endocrine toxicity of checkpoint inhibitors to improve both endocrine and oncological care. In particular the importance of considering any inflammatory phase (such as painful thyroiditis or hypophysitis resulting in pituitary enlargement), form the endocrine consequences (transient hyperthyroidism followed by hypothyroidism, pan-hypopituitarism or isolated ACTH deficiency), is highlighted. It is also important to consider the potential confounder of exogenous corticosteroids in adrenal suppression.