title: Ipilimumab treatment associated pituitary hypophysitis: clinical presentation and imaging diagnosis.
abstract: Ipilimumab is an immunomodulating drug for use in treatment of unresectable or metastatic melanoma with autoimmune lymphocytic hypophysitis as a reported complication. We describe three recent cases of ipilimumab associated autoimmune hypophysitis (IAH) at our institution, and provide a selected literature review showing its variable clinical presentation, imaging appearance and treatment in order to expedite early and appropriate IAH management. Patients had variable clinical presentation of hypophysitis, including headache, fatigue, visual changes, endocrinopathy, and/or hyponatremia. Contrast enhanced MRI showed symmetric pituitary gland and stalk enlargement in all of our cases and received a presumptive diagnosis of IAH. Following cessation of therapy and treatment there was normalization of pituitary morphology at follow-up MRI and return to clinical baseline. Varying clinical presentation can complicate the diagnosis of lymphocytic hypophysitis. One must be cognizant of its overall clinical and radiologic picture in patients receiving ipilimumab, now commonly used for the treatment of metastatic melanoma.
authors.affiliation: Alpert Medical School, Brown University, 222 Richmond St, Providence 02903, USA.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Chodakiewitz
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence 02903, USA.
authors.forename: Sanford
authors.initials: S
authors.lastname: Brown
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence 02903, USA.
authors.forename: Jerrold L
authors.initials: JL
authors.lastname: Boxerman
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence 02903, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Brody
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence 02903, USA. Electronic address: jrogg@lifespan.org.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rogg
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003952:Diagnostic Imaging; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000188:drug therapy*; D000074324:Ipilimumab; D008279:Magnetic Resonance Imaging / Q000379:methods; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy*; D010902:Pituitary Gland / Q000473:pathology*
chemical_list: D000911:Antibodies, Monoclonal; D000074324:Ipilimumab
keywords: Autoimmune lymphocytic hypophysitis; Ipilimumab; MRI; Melanoma; Pituitary