Anticytotoxic T-Lymphocyte Antigen-4 Induced Autoimmune Hypophysitis: A Case Report and Literature Review

Table 2

Toxicity grading and endocrine adverse events associated with immune checkpoint inhibitors, according to Common Terminology Criteria for Adverse Events (CTCAE) of National Institutes of Health (National Cancer Institute) [2].

Endocrine adverse event	Grade	Description
Hypothyroidism	1	Asymptomatic; clinical or diagnostic observations only; intervention not indicated
	2	Symptomatic; thyroid replacement indicated; limiting instrumental activity of daily living (ADL)
	3	Severe symptoms; limiting self-care ADL; hospitalization indicated
	4	Life-threatening consequences; urgent intervention indicated
	5	Death
Hyperthyroidism	1	Asymptomatic; clinical or diagnostic observations only; intervention not indicated
	2	Symptomatic; thyroid suppression therapy indicated; limiting instrumental activity of daily living (ADL)
	3	Severe symptoms; limiting self-care ADL; hospitalization indicated
	4	Life-threatening consequences; urgent intervention indicated
	5	Death
Adrenal insufficiency	1	Asymptomatic; clinical or diagnostic observations only; intervention not indicated
	2	Moderate symptoms; medical intervention indicated
	3	Severe symptoms; hospitalization indicated
	4	Life-threatening consequences; urgent intervention indicated
	5	Death
Hypophysitis	1	Asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated
	2	Moderate; minimal, local or noninvasive; intervention indicated; limiting age-appropriate instrumental ADL
	3	Severe or medically significant but not immediately life-threatening; symptoms; hospitalization or prolongation of existing hospitalization indicated; disabling; limiting self-care ADL
	4	Life-threatening consequences; urgent intervention indicated
	5	Death