Table 2.

Management of hypopituitarism induced by immune checkpoint inhibitors.

CTCAE Grade	Management	Treatment of Adverse Event
Grade 1	Hormone supplementation as needed	Consider consultation with an endocrinologist If adrenal insufficiency is suspected, start hydrocortisone 10–20 mg BID Start testosterone or estrogen replacement therapy if needed
Grade 2	Stop ICI treatment until symptoms stabilize by hormone supplementation After amelioration of symptoms, resume administration of ICI	Consult an endocrinologist Consider pituitary imaging Perform hormone replacement therapy as performed for Grade 1 events Perform frequent thyroid function and other hormonal tests until baseline levels are achieved
Grade 3	Same as above	Consult an endocrinologist Consider pituitary imaging Perform a pituitary function test on hospitalization If adrenal insufficiency is present, start hydrocortisone 15–30 mg BID Perform hormone replacement therapy as performed for Grade 1 events Perform frequent thyroid function and other hormonal tests until baseline levels are achieved
Grade 4	Stop ICI treatment Resume administration after recovery from crisis and stabilization of symptoms	Perform full-body management during hospitalization Consult an endocrinologist Immediately start administration of hydrocortisone 100–200 mg BID Physiological saline infusion under cardiac function monitoring Consider pituitary imaging Perform frequent thyroid function and other hormonal tests until baseline levels are achieved

CTCAE, Common Terminology Criteria for Adverse Events; ICI, immune checkpoint inhibitor; BID, bis in die