. Author manuscript; available in PMC: 2022 Jan 19.

Published in final edited form as: Nat Rev Endocrinol. 2021 Apr 19;17(7):389–399. doi: 10.1038/s41574-021-00484-3

Table 1:

Summary of screening, testing, and treatment of ICI-associated endocrinopathies.

Gland	ICI	Hormone	Disease	Testing	Results	Treatment
Pituitary (anterior)	C >> P	n/a	Hypophysitis	Pituitary MRI if compressive symptoms, hormonal tests as below	Sellar mass, hypophyseal enlargement	Prednisone/methylprednisolone 1-2mg/kg/day if severe symptoms
		ACTH	Secondary AI	AM cortisol and ACTH (with symptoms or every CTLA-4 cycle)	Cortisol low ACTH low	Glucocorticoid replacement (HC 20mg AM and 10mg PM, starting dose)
		TSH	Secondary hypothyroidism	TSH, FT4 (every 4-6 weeks)	TSH low or low-normal with FT4 low	Levothyroxine replacement (1.6mcg/kg starting dose)
		LH/FSH	Secondary hypogonadism	AM testosterone or estrogen, LH, FSH (with symptoms)	AM testosterone low x2, Estrogen low, LH and FSH low	Testosterone/Estrogen replacement if not contraindicated
Thyroid	D > P > C	Thyroxine	Thyrotoxicosis	TSH, FT4 (every 4-6 weeks)	TSH low, FT4 high	Supportive, +/− beta blocker, evaluate for other causes if persistent > 6 weeks
Thyroid	D > P > C	Thyroxine	Hypothyroidism	TSH, FT4 (every 4-6 weeks)	TSH high, FT4 low	Levothyroxine replacement if TSH>10 (1.6mcg/kg starting dose)
Pancreas	P	Insulin	ICI-DM	Random or fasting BG (every 4-6 weeks)	BG high	Evaluate and treat DKA as appropriate, Insulin (basal-bolus regimen)
Adrenal	D > C = P	Cortisol +/− Aldosterone	Primary AI	AM cortisol and ACTH, BMP (with symptoms)	Cortisol low, ACTH high, Na low, K high, CO2 low	Glucocorticoid replacement (HC 20mg AM and 10mg PM, starting dose) +/− Mineralicorticoid replacement (fludricortisone 0.1mg daily, starting dose)

For detailed testing and management recommendations, see clinical practice guidelines by the National Comprehensive Cancer Network⁵⁶ and by the American Society of Clinical Oncology⁷⁸.

ACTH, adrenocorticotropic hormone; TSH, thyroid stimulating hormone; LH, luteinizing hormone; FSH, follicle stimulating hormone; AI, adrenal insufficiency; ICI-DM, immune checkpoint inhibitor associated diabetes mellitus; BMP, basic metabolic panel; FT4, free thyroxine; DKA, diabetic ketoacidosis; HC, hydrocortisone; ; C, CTLA-4 inhibition; P, PD-1/PD-L1 inhibition; D, dual therapy.