Ipilimumab-induced hypophysitis: early Australian experience

Sunita M C De Sousa, Georgina V Long and Katherine T Tonks
Med J Aust 2014; 201 (4): . || doi: 10.5694/mja14.00803
Published online: 18 August 2014

To the Editor: We report two men aged in their 60s receiving ipilimumab for metastatic melanoma who presented with headache and constitutional symptoms after the third 3-weekly dose, and were diagnosed with ipilimumab-induced hypophysitis. Ipilimumab is a monoclonal antibody that binds to cytotoxic T lymphocyte-associated antigen 4, resulting in T-cell activation and proliferation. It was the first therapy to yield a survival benefit in metastatic melanoma,1 but at the cost of frequent immune-related adverse events.2

  • 1 Department of Endocrinology, St Vincent's Hospital, Sydney, NSW.
  • 2 Melanoma Institute Australia, Sydney, NSW.
  • 3 Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW.



We thank Diana Adams of Macarthur Cancer Therapy Centre at Campbelltown Hospital, Sydney, who shared in patient care.

Competing interests:

Georgina Long is a consultant adviser to Bristol-Myers Squibb, Merck, Amgen, GlaxoSmithKline, Novartis and Roche.

  • 1. Hodi FS, O'Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 2010; 363: 711-723.
  • 2. Ryder M, Callahan M, Postow MA, et al. Endocrine-related adverse events following ipilimumab in patients with advanced melanoma: a comprehensive retrospective review from a single institution. Endocr Relat Cancer 2014; 21: 371-381.
  • 3. Gutenberg A, Larsen J, Lupi I, et al. A radiologic score to distinguish autoimmune hypophysitis from nonsecreting pituitary adenoma preoperatively. Am J Neuroradiol 2009; 30: 1766-1772.
  • 4. Torino F, Barnabei A, De Vecchis L, et al. Hypophysitis induced by monoclonal antibodies to cytotoxic T lymphocyte antigen 4: challenges from a new cause of a rare disease. Oncologist 2012; 17: 525-535.
  • 5. Blansfield JA, Beck KE, Tran K, et al. Cytotoxic T-lymphocyte–associated antigen-4 blockage can induce autoimmune hypophysitis in patients with metastatic melanoma and renal cancer. J Immunother 2005; 28: 593-598.


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