Hypophysitis

Assessment and Investigations

Hypophysitis Unlikely
  • Random cortisol >160 µg/L
Likely
  • Random cortisol <160 µg/L

Rule out mass-effect symptoms of hypophysitis, adrenal crisis, rule out sepsis
Perform MRI of the pituitary gland + whole brain imaging (exclude metastasis)


Management

  • Urgent hydrocortisone stress dose of hydrocortisone 100mg IV (or IM)
  • Intravenous hydration
  • Hold ICPI
  • Taper to physiological hydrocortisone substitution in consultation with Endocrinology
  • If low fT4 and low/normal TSH, first await 72h of hydrocortisone substitution before starting thyroxine replacement therapy
  • Restart ICPI once adequately substituted
Abbreviations

Abbrevations

ICPi: Immune Checkpoint Blockade Inhibition
TSH: Thyroid-Stimulating Hormone
FT4: Free Thyroxin