Enlargement of the pituitary gland is heterogenous in the etiology. Common causes of pituitary enlargement are physiological hypertrophy during pregnancy, primary and secondary tumors, autoimmune hypophysitis including side effects of anticancer therapy with check-point inhibitors. Terms like hypertrophy, hyperplasia, sellar expansion and hypophysitis are commonly used to describe enlargement of the pituitary gland on MR scan regardless its etiology. The most common pathology causing pituitary gland enlargement is pituitary adenoma. Magnetic resonance imaging can differentiate pituitary tumors from diffuse enlargement due to hypophysitis in most but not all cases. Changes on imaging during time or response to pharmacotherapy might help determine the final diagnosis in uncertain cases. We present a case report of a young woman with sellar expansion due to prolonged untreated peripheral hypothyroidism mimicking pituitary adenoma. Interdisciplinary cooperation of endocrinologist, radiologist and neurosurgeon is crucial in determining the diagnosis.
- Klíčová slova
- Hypothyroidism, Pituitary adenoma, checkpoint inhibitors, hypophysitis, hypothyroidism, immune checkpoint inhibitors, pituitary tumor, sellar expansion,
- MeSH
- adenom * komplikace diagnóza MeSH
- diferenciální diagnóza MeSH
- hypertrofie MeSH
- hypofýza diagnostické zobrazování patologie MeSH
- hypofyzitida * MeSH
- hypotyreóza * komplikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory hypofýzy * komplikace diagnóza MeSH
- nemoci hypofýzy * komplikace diagnóza MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVES: Immune checkpoints inhibitors (ICI) represent a new therapy option for the treatment of several advanced tumors. However, this therapy has been linked to a spectrum of ICI related autoimmune (AI) adverse events. Some may be life threatening and their diagnosis is tricky. The aim of our study was to describe various imaging appearances of ICI related secondary hypophysitis and other coincidental AI diseases. MATERIAL AND METHODS: We included 28 patients (19 females, 9 men, mean aged 58±13 years), who were consecutively treated mostly for advanced stage melanoma by different ICI. All their CT/MRI records and clinical data were reviewed. RESULTS: We found 5 (18%) cases of endocrinology proven secondary hypophysitis; 2 cases of panhypopituitarism and 3 cases of central hypocortisolism. Four cases were MRI positive, 1 case was MRI negative. Three cases were accompanied by other AI diseases: 1 by hemorrhagic colitis and mesenterial lymphadenitis, 1 by AI pancreatitis and 1 by pneumonitis. On MRI pituitary gland was swollen in 3 cases, twice enhanced non-homogenously, once homogenously; infundibular enlargement was present in 2 cases. Those 3 cases reacted to glucocorticoid therapy by hypophyseal shrinkage. In 1 case of MRI positive hypophysitis, the pituitary gland was not enlarged, slightly nonhomogeneous with peripheral contour enhancement; no reaction to glucocorticoids was mentioned. CONCLUSION: Secondary hypophysitis is probably more common ICI related adverse event than reported in the literature. Its MRI appearance is variable. Most of our cases were in coincidence with other AI ICI related events that affected their clinical manifestations.
- MeSH
- autoimunitní nemoci chemicky indukované MeSH
- dospělí MeSH
- humanizované monoklonální protilátky škodlivé účinky MeSH
- hydrokortison nedostatek MeSH
- hypofýza diagnostické zobrazování MeSH
- hypopituitarismus chemicky indukované diagnostické zobrazování MeSH
- ipilimumab škodlivé účinky MeSH
- kolitida chemicky indukované MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenitida chemicky indukované MeSH
- lymfocytární hypofyzitida chemicky indukované diagnostické zobrazování MeSH
- magnetická rezonanční tomografie MeSH
- melanom farmakoterapie patologie MeSH
- mezenterium MeSH
- nádory kůže farmakoterapie patologie MeSH
- pankreatitida chemicky indukované MeSH
- pneumonie chemicky indukované diagnostické zobrazování MeSH
- počítačová rentgenová tomografie MeSH
- protinádorové látky imunologicky aktivní škodlivé účinky MeSH
- retrospektivní studie MeSH
- senioři MeSH
- staging nádorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- humanizované monoklonální protilátky MeSH
- hydrokortison MeSH
- ipilimumab MeSH
- pembrolizumab MeSH Prohlížeč
- protinádorové látky imunologicky aktivní MeSH
Treatment with tyrosine kinase inhibitors leads to thyroid dysfunction in up to one half of treated patients, hypothyroidism being the most common. It is caused by destructive thyroiditis, impaired transport of T4 into the cell and deiodinase induction. Bexarotene is a nuclear retinoid X receptor agonist. Its application is accompanied with central hypothyroidism and hypertriglyceriaemia in virtually all patients and it also increases thyroxin metabolism. Autoimmune endocrine side effects are common in cancer immunotherapy. Cytokines (interpheron α and interleukin 2) cause autoimmune thyroiditis in 2-10 % of treated patients. Therapy with immune checkpoints inhibitors is connected with a variety of immune-related adverse events (irAE). Endocrine irAE include hypophysitis and thyroiditis during treatment with monoclonal antibodies against CTLA4 and thyroid dysfunction during therapy with antibody against CD1 receptor and its ligand. Knowledge, early recognition and management of these side effects is crucial.Key words: bexarotene - endocrine complication - hypophysitis - immune checkpoint inhibitors - immunotherapy.
- MeSH
- antigen CTLA-4 antagonisté a inhibitory MeSH
- antikarcinogenní látky škodlivé účinky MeSH
- autoimunitní tyreoiditida chemicky indukované MeSH
- bexaroten MeSH
- hypofyzitida chemicky indukované MeSH
- hypotyreóza chemicky indukované MeSH
- imunoterapie MeSH
- inhibitory proteinkinas škodlivé účinky MeSH
- ipilimumab MeSH
- lidé MeSH
- monoklonální protilátky škodlivé účinky MeSH
- nádory farmakoterapie MeSH
- nemoci štítné žlázy chemicky indukované MeSH
- protinádorové látky škodlivé účinky MeSH
- tetrahydronaftaleny škodlivé účinky MeSH
- thyroxin metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antigen CTLA-4 MeSH
- antikarcinogenní látky MeSH
- bexaroten MeSH
- CTLA4 protein, human MeSH Prohlížeč
- inhibitory proteinkinas MeSH
- ipilimumab MeSH
- monoklonální protilátky MeSH
- protinádorové látky MeSH
- tetrahydronaftaleny MeSH
- thyroxin MeSH
