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Resume Les indications des inhibiteurs de checkpoint (ICP) immunitaire sont maintenant tres etendues et ont fait emerger des complications endocriniennes specifiques avec lesquelles les oncologues ont du se familiariser. L’hypophysite en est un exemple typique, devenue une complication non rare des ICPs, touchant jusqu’a 10 % des patients traites par anti-CTLA4. Elle survient classiquement deux a trois mois apres l’initiation du traitement. Le tableau associe typiquement cephalees et alteration de l’etat general, associees a une hyponatremie. Les atteintes hormonales les plus frequentes touchent les secteurs thyreotropes, gonadotrope et corticotrope. L’atteinte corticotrope fait la gravite de cette pathologie, necessitant la mise en place urgente d’une supplementation, sans attendre la confirmation biologique dans les cas severes. L’IRM doit etre systematiquement realisee, essentiellement pour eliminer les diagnostics differentiels, dont les metastases hypophysaires. L’hypophysite induite par les ICPs de type anti-PD1/PDL1 est une entite a part, de survenue retardee, pauci-symptomatique, mais caracterisee par une insuffisance corticotrope systematique et definitive, le plus souvent isolee au vu des premieres donnees publiees. Le traitement repose sur la corticotherapie a forte dose uniquement en cas de cephalees resistantes ou d’insuffisance corticotrope decompensee, et sur la supplementation hormonale systematique des deficits antehypophysaires. Les patients necessiteront une supplementation hormonale a vie, et doivent etre pris en charge et eduques en endocrinologie. Une fois l’episode aigu resolu, l’immunotherapie peut etre poursuivie si le patient en a un benefice. Compte tenu du caractere peu symptomatique et de la gravite potentielle de ces hypophysites, une surveillance biologique systematique est necessaire pendant le traitement par ICPs.

International audience; Checkpoint inhibitors immunotherapy is more and more prescribed in oncology, causing new immune related endocrine adverse events. Hypophysitis occurs in approximately 10 % of patients treated with anti-CTLA4. It occurs two to three months after initiation of the immunotherapy. The initial presentation is characterized, in typical forms, by the association of headache, asthenia and hyponatremia. Hormonal exploration usually shows ACTH, gonadotropic and thyrotropic deficiencies. ACTH deficiency may be life-threatening and requires urgent supplementation, without awaiting for biological results. MRI is warranted in order to exclude differential diagnoses, such as pituitary metastases. Hypophysitis induced by anti-PD1/PDL1 seems to be a different nosologic entity characterized by a later onset and a less symptomatic presentation. Biologically ACTH deficiency seems to be constant and permanent, and often isolated. Treatment requires high-dose steroids only in case of severe tumor syndrome (resistant headache, visual disturbance) or acute decompensation of ACTH deficiency. Patients always need lifelong hormonal supplementation of pituitary deficits and must be followed and educated specifically. Immunotherapy can be delayed during the acute phase, but can be secondarily continued if there is an oncological benefit. As it is a pauci-symptomatic but potentially life-threatening complication, biological screening must be systematic in patients treated with checkpoint inhibitors.

AIMS: Programmed cell death-1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors restore antitumor immunity, but many autoimmune side-effects have been described. Diabetes mellitus is a rare complication, and little data concerning its pathophysiology and phenotype have been published. This study aimed to describe both pancreatic endocrine and exocrine functions, immunological features and change in pancreas volume in subjects with diabetes mellitus induced by PD-1 and PD-L1 inhibitors. METHODS: We analyzed the data of six subjects treated with immunotherapy who presented acute diabetes. RESULTS: There were five men and one woman. Median age was 67 years (range 55-83). Three subjects were treated with nivolumab, two with pembrolizumab and one with durvalumab. Median time to diabetes onset after immunotherapy initiation was 4 months (range 2-13). Four patients presented fulminant diabetes (FD); none of these had type 1 diabetes (T1D)-related autoantibodies, none of them had T1D or FD-very high-risk HLA class II profiles. The bi-hormonal endocrine and exocrine pancreatic failure previously reported for one FD patient was not found in other FD subjects, but glucagon response was blunted in another FD patient. Pancreas volume was decreased at diabetes onset in 2 FD patients, and all patients presented a subsequent decrease of pancreas volume during follow-up. CONCLUSIONS: In the patients presented herein, immunotherapy-induced diabetes was not associated with T1D-related autoantibodies. The hormonal and morphological analysis of the pancreatic glands of these six cases contributes to the understanding of the underlying and probably heterogeneous mechanisms. There is a need to find biomarkers to identify patients at risk to develop these new forms of diabetes at early stages of the process to prevent ketoacidosis and to evaluate preventive strategies.