ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1614223
This article is part of the Research TopicEndocrine Diseases Related to Immune Checkpoint InhibitorsView all articles
Retrospective analysis of clinical characteristics and treatment of patients with immune checkpoint inhibitors-induced adrenal insufficiency
Provisionally accepted
Xiao Huang1
Lin Zhang1
Chuantao Zhang2Huiyun Wang2
Zhuhai Shao1
Ning Liu2Shanai Song2
Man Jiang2
Helei Hou2*- 1Qingdao University, Qingdao, China
- 2The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Immune checkpoint inhibitors (ICIs) are effective against solid tumors but can cause immune-related adverse events (irAEs), including adrenal insufficiency (AI). This study investigates the clinical characteristics and outcomes of ICI-induced AI (ICI-AI). In addition, we searched for clinical trials and real-world studies on ICI-AI. Retrospective analysis of 46 patients from a single center (May 2019 -July 2024) revealed 22 cases of isolated adrenocorticotropic hormone deficiency (IAD), 23 of hypophysitis, and one of primary adrenal insufficiency (PAI). Median time to AI onset was 7.8 months (range: 1.5 -27.4), with a median of 7 ICI cycles (range: 1 -21). Common symptoms included fatigue, anorexia, and nausea. Comorbidities included hypothyroidism (41.3%) and hyponatremia (63%). No adrenocorticotropic hormone (ACTH) deficiency patients recovered during follow-up, but glucocorticoid replacement improved symptoms in most cases (45/46). The objective remission rate of underlying diseases post-AI was 63%. Concurrent irAEs in other organs were rare (3 cases). Findings highlight the importance of monitoring cortisol levels during ICIs therapy for early AI detection. Both IAD and hypophysitis are common secondary adrenal insufficiency (SAI) manifestations, and patients can safely resume ICIs therapy with glucocorticoid replacement.
Keywords: immune checkpoint inhibitors, immune-associated adverse events, Adrenal Insufficiency, Isolated adrenal deficiency, hypophysitis
Received: 18 Apr 2025; Accepted: 20 Jul 2025.
Copyright: © 2025 Huang, Zhang, Zhang, Wang, Shao, Liu, Song, Jiang and Hou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Helei Hou, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
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