Hypophysitis
Inflammation of the pituitary from autoimmunity (classically late pregnancy or postpartum), IgG4 disease, systemic disease or immune checkpoint inhibitors. Recognise early ACTH deficiency, replace hydrocortisone before thyroxine, and keep high-dose steroids for mass effect.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Inflammation of the pituitary gland or stalk causing headache, hypopituitarism, AVP deficiency and sometimes visual loss.
- In medical wards the commonest cause is now immune checkpoint inhibitors, especially ipilimumab. In young women, think lymphocytic hypophysitis late in pregnancy or postpartum.
- Unlike an adenoma, ACTH deficiency comes early and may be isolated. The first presentation can be adrenal crisis.
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Sources
- Endocrine-related adverse conditions in patients receiving immune checkpoint inhibition: an ESE clinical practice guidelineEuropean Society of Endocrinology (Husebye et al., Eur J Endocrinol 2022;187:G1-G21), 2022
- Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-upESMO (Haanen et al., Ann Oncol 2022;33:1217-38), 2022
- Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline updateASCO (Schneider et al., J Clin Oncol 2021;39:4073-126), 2021
- Management of immune-related adverse events (irAEs), ID 1993AU/NZeviQ, Cancer Institute NSW, v6
- Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guidelineEndocrine Society (Fleseriu et al., J Clin Endocrinol Metab 2016;101:3888-921), 2016
- High-dose glucocorticoids for the treatment of ipilimumab-induced hypophysitis is associated with reduced survival in patients with melanomaCancer (Faje et al., 2018;124:3706-14), 2018
- Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: a systematic review and meta-analysisJAMA Oncology (Barroso-Sousa et al., 2018;4:173-82), 2018
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main