Ipilimumab-Induced Hypophysitis May Not Affect All Pituitary Cell Lines: A Case Report
Bibliographic record
Abstract
Hypophysitis, a rare autoimmune condition, has now emerged as an adverse effect of ipilimumab (anti-cytotoxic T lymphocyte antigen 4 (CTLA4) mAb) therapy. The occurrence of ipilimumab-induced hypophysitis (IH) in studies has varied from 0% to 17%. This condition, because of secondary adrenal insufficiency, may be life-threatening if not recognized and managed promptly. Here we present a case of hypophysitis in the setting of ipilimumab therapy for malignant melanoma. The patient initially presented to his oncologist with a headache, diplopia, fatigue, nausea, hot flashes, anorexia and decreased libido shortly following the third cycle of ipilimumab. He was found to have pituitary enlargement with heterogeneous enhancement on magnetic resonance imaging (MRI). The initial diagnosis was based on clinical features, MRI findings and laboratory evidence of central hypogonadism and adrenal insufficiency. Other hormone levels were not tested that time and were only tested 5 months later when the patient did not tolerate the discontinuation of glucocorticoids. He continued to require glucocorticoid and testosterone replacement 14 months after the diagnosis. This case demonstrates IH causing anterior hypopituitarism leading to central hypoadrenalism, central hypogonadism, reduced prolactin and possibly central hypothyroidism but preserved somatotroph function. Pituitary antibodies may be a possible method of detection of IH in addition to MRI and hormonal investigations. There is insufficient evidence to support the need for discontinuing ipilimumab or the superiority of initial high dose versus physiologic steroid and hormone replacement in the management of IH. Hypopituitarism due to IH may persist for several months or longer after ipilimumab is discontinued. This underlies the importance of continuous supplementation with all the hormones that are deficient as a consequence of hypopituitarism caused by IH. J Endocrinol Metab. 2015;5(5):299-303 doi: http://dx.doi.org/10.14740/jem287w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".