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Emergency ambulatory outpatient management of immune-mediated hypophysitis

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Abstract

Purpose

Immune-mediated hypophysitis is an important toxicity related to immune checkpoint inhibitors (ICI). Optimal management is associated with improved outcomes. It represents a wide spectrum of clinical presentations, and a proportion may be suitable for emergency ambulatory management.

Methods

Emergency ambulatory management of patients presenting with clinical features and findings consistent with ICI-induced hypophysitis was considered at a tertiary cancer/endocrinology hospital. Suitable patients were initially investigated and treated in accordance with the UK emergency management guidelines for ICI induced hypophysitis. After an initial observation period of 4 h, patients were discharged with oral hydrocortisone (20, 10, 10 mg).

Results

An initial cohort of 4 patients with emergency presentations of ICI-induced hypophysitis has been managed in an ambulatory fashion in the first 3 months. There were no 30-day readmissions.

Conclusion

Carefully selected emergency presentations with immune-mediated hypophysitis may be suitable for ambulatory management.

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Authors and Affiliations

  1. Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK

    Tim Cooksley & Tom Knight

  2. Department of Medical Oncology, The Christie, Wilmslow Road, Manchester, UK

    Avinash Gupta & Paul Lorigan

  3. Department of Endocrinology, The Christie, Wilmslow Road, Manchester, UK

    Claire Higham & Safwaan Adam

  4. Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

    Claire Higham

Authors
  1. Tim Cooksley
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  2. Tom Knight
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  3. Avinash Gupta
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  4. Claire Higham
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  5. Paul Lorigan
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  6. Safwaan Adam
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Corresponding author

Correspondence to Tim Cooksley.

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Cooksley, T., Knight, T., Gupta, A. et al. Emergency ambulatory outpatient management of immune-mediated hypophysitis. Support Care Cancer 28, 3995–3999 (2020). https://doi.org/10.1007/s00520-020-05581-z

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  • DOI: https://doi.org/10.1007/s00520-020-05581-z

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