# Immune-related endocrinopathies (thyroiditis, hypophysitis)

Source: https://onco.cc/terms/immune-endocrinopathy/  
OnCo record `immune-endocrinopathy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.

## Summary

Thyroid dysfunction affects 10-20% of patients on PD-1/PD-L1 antibodies, usually a transient thyroiditis followed by permanent hypothyroidism managed with levothyroxine without stopping immunotherapy; hypophysitis is characteristic of ipilimumab (5-10%) and causes headache, fatigue and low cortisol requiring permanent hydrocortisone; fulminant type 1 diabetes and primary adrenal insufficiency are rare but acute. Unlike most immune-related adverse events, endocrinopathies are generally irreversible because the gland is destroyed, but they are also compatible with continued treatment, and some data link them to better response. Kinase inhibitors (lenvatinib, sunitinib) cause hypothyroidism by a different mechanism.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: endocrinopathy; endocrinopathies; hypothyroidism; hyperthyroidism; thyroiditis; thyroid dysfunction; hypophysitis; adrenal insufficiency; immune-related diabetes; type 1 diabetes; thyroid function tests; TSH monitoring; hormone replacement

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hypophysitis
- Haanen et al., Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline (Annals of Oncology 2022): https://doi.org/10.1016/j.annonc.2022.10.001

## Connected records

- terms: [Immune-mediated colitis and diarrhoea](https://onco.cc/terms/immune-colitis/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Immune-related myocarditis](https://onco.cc/terms/myocarditis/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- drugs: [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- key papers: [Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-haanen-ann-oncol/)

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