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Cited by 136Cancer Immunotherapy and BiomarkersAdrenal Hormones and DisordersPituitary Gland Disorders and Treatments

SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy

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Higham, C E, Olsson-Brown, A, Carroll, P, Cooksley, T, Larkin, J, Lorigan, P, Morganstein, D, Trainer, P J +1 more·2018·Endocrine Connections
DOI 10.1530/ec-18-0068PMC PMC6013692
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Abstract

Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3–4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1–2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed.

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  • Expert consensus statements and guidelines exist on the management of adrenal insufficiency and emphasis is placed on the importance of prompt initiation of treatment in patients with suspected adrenal crisis.

    “Expert consensus statements and guidelines exist on the management of AI and above all, emphasis is placed on the importance of prompt initiation of treatment in patients with suspected adrenal crisis.18,51,52”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [52]

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Research works printed but not linked: 16

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Authors
Higham, C. E., Olsson-Brown, A., Carroll, P., Cooksley, T., Larkin, J., Lorigan, P., Morganstein, D., Trainer, P. J., & _, _.
Affiliations
  • Manchester Academic Health Science Centre (GB)
  • University of Liverpool (GB)
  • Guy's and St Thomas' NHS Foundation Trust (GB)
  • The Christie Hospital (GB)
  • Royal Marsden Hospital (GB)
  • Chelsea and Westminster Hospital (GB)
  • Society for Endocrinology (GB)
Corresponding author
Higham, C E
ORCID
Venue
Endocrine Connections
Publisher
Bioscientifica
Published
2018-07
Volume
7
Issue
7
Pages
G1-G7
ISSN
2049-3614 (ISSN-L)
DOI
10.1530/ec-18-0068
PMC
PMC6013692
OpenAlex
W2809211230
Cited by
136
References
5
Citations by year
2026: 10 · 2025: 12 · 2024: 17 · 2023: 16 · 2022: 25 · 2021: 22 · 2020: 21 · 2019: 9 · 2018: 4
FWCI
5.26
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrine Connections (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc)
Funders
Medical Research Council (MR/N025989/1)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Keywords
immune checkpoint inhibitors, immune-related adverse events, endocrine complications, hypophysitis, adrenalitis, thyroiditis, adrenal insufficiency, CTLA-4 inhibitors, PD-1 inhibitors, glucocorticoid therapy, emergency management, management algorithm, CTCAE grading

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