Friday, September 26, 2014

Ipi induced hypophysitis

Ipilimumab-induced Hypophysitis:  A detailed longitudinal analysis in a large cohort of patients with metastatic melanoma.
Faje, Sullivan, Lawrence, et al.  J Clin Endocrinal Metab.  2014 Jul 31

"Little is known about ipi-induced hypophysitis, an important treatment complication."  Retrospective review.  154 patients with metastatic melanoma, treated with ipi between March 2008 and December 2013.  Evaluated:  Pituitary MRI, pituitary hormone assessment, and patient survival. Condition was found in 17 patients (11%).  Being male and older were risk factors, cumulative dose of ipi was not.  All patients had anterior hypopituitarism, none had diabetes insipidus.  Was persistent in most (76%).  "Diffuse pituitary enlargement was observed exclusively in all cases and, upon retrospective review of MRI's, this finding preceded the clinical diagnosis of hypophysitis in 8 patients.  Median survival in patients with ipi induced hypophysitis was 19.4 vs 8.8 months in the remainder cohort."
Conclusions:  "Male gender and older age are risk factors.  Pituitary enlargement is sensitive and specific....can precede clinical diagnosis, and resolves rapidly.  Anterior pituitary function recovery is uncommon.  Incidence of hypophysitis may positively predict survival in melanoma patients treated with ipi."

 For what it's worth....hang in there ratties!!! - c

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