With a history of ipilimumab/nivolumab, severe immune-related colitis, and other questions about hydrocortisone, cortisol, levothyroxine and adrenal function, an endocrinologist plays a key role in ensuring that any hormone deficiencies are managed safely alongside your ongoing cancer treatment.
Endocrinology is the branch of medicine that deals with the body’s hormone-producing glands, including the:
- Pituitary gland (the “master gland” in the brain)
- Thyroid gland
- Adrenal glands
- Pancreas (which produces insulin)
- Testes or ovaries
These glands regulate energy, blood pressure, metabolism, stress response, temperature, sexual function, and many other essential functions.
Why is it important after immunotherapy?
Immunotherapy can cause immune-related endocrine disorders. The most common are:
- Adrenal insufficiency
- The adrenal glands may stop producing enough cortisol.
- This can be life-threatening if not recognised.
- Symptoms include severe fatigue, dizziness, low blood pressure, nausea, weight loss and weakness.
- Hypophysitis (inflammation of the pituitary gland)
- More common with ipilimumab.
- The pituitary controls several other glands, so damage can affect:
- Cortisol production
- Thyroid function
- Testosterone
- Growth hormone
- Thyroid disease
- Initially an overactive thyroid may occur.
- This often progresses to an underactive thyroid requiring lifelong levothyroxine.
- Type 1 diabetes
- Less common, but immunotherapy can destroy insulin-producing cells.
- This can develop rapidly and requires insulin treatment
What does an endocrinologist do?
An endocrinologist will:
- Monitor hormone levels regularly.
- Diagnose endocrine side effects early.
- Prescribe hormone replacement when needed.
- Adjust medication during illness, surgery or stress.
- Educate patients about emergency situations such as adrenal crisis.
Some useful questions for a consultation include:
- Which endocrine glands have been affected by my immunotherapy?
- Is my adrenal insufficiency expected to be permanent?
- Do I need regular pituitary hormone testing?
- Are my hydrocortisone and levothyroxine doses appropriate?
- What blood tests should I have and how often?
- What are my sick-day rules, and when should I double or triple my hydrocortisone?
- Should I carry an emergency steroid injection and wear a medical alert bracelet?
- Could my testosterone or other hormones also have been affected?
- Which symptoms should make me seek urgent medical attention?
Because many endocrine side effects of immunotherapy can persist for life, good endocrinology follow-up is just as important as ongoing oncology follow-up. The encouraging aspect is that, once identified, most hormone deficiencies can be managed very effectively with replacement therapy, allowing people to maintain a good quality of life.
