{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:44:58Z","timestamp":1792111498369,"version":"4.4.0"},"reference-count":39,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Limited data are available on quality of life (QoL) and adrenal crises in patients with immune checkpoint inhibitor\u2013induced secondary adrenal insufficiency (ICI-SAI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To (1) characterize the presentation, management, and outcomes of patients with ICI-SAI; (2) compare outcomes of ICI-SAI with other etiologies of secondary adrenal insufficiency (oSAI); and (3) identify variables associated with QoL and adrenal crisis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center cross-sectional study, adults with ICI-SAI or oSAI (2018-2025) completed questionnaires assessing symptoms, management, adrenal crises, and the Addison\u2019s Disease\u2013Specific QoL survey (AddiQoL); outcomes included AddiQoL score and adrenal crisis events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with ICI-SAI (n = 109) were older (median age 66 vs 60 years), more often women (59% vs 43%), and more frequently diagnosed within 1 year of symptom onset (88% vs 42%, P &amp;lt; .001), compared to patients with oSAI (n = 139). Patients with ICI-SAI had higher AddiQoL scores (median 87 vs 85, P = .020). In a multivariable analysis of age, sex, glucocorticoid dose and type, insurance support, and duration of SAI, ICI-SAI remained independently associated with higher AddiQoL (estimate 5.4, P = .010). The prevalence of reported adrenal crises within the prior year was similar between groups (15% vs 14%, P = .782). In a multivariable analysis, higher AddiQoL scores were independently associated with lower odds of adrenal crisis (OR 0.57; 95% CI 0.42-0.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with ICI-SAI report better QoL compared with patients with other causes of SAI, despite similar adrenal crisis rates. These differences may be related to earlier diagnosis and differing clinical contexts, underscoring the importance of timeline recognition and patient-centered management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag219","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:41:52Z","timestamp":1779968512000},"page":"e2369-e2381","source":"Crossref","is-referenced-by-count":1,"title":["Determinants of quality of life in patients with immune checkpoint inhibitor\u2013induced secondary adrenal insufficiency"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5665-0617","authenticated-orcid":false,"given":"Justine","family":"Herndon","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4413-2235","authenticated-orcid":false,"given":"Yana","family":"Hleibiehova","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara J","family":"Achenbach","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra N","family":"Bancos","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1191-3775","authenticated-orcid":false,"given":"Elizabeth J","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5091-9582","authenticated-orcid":false,"given":"Diane","family":"Donegan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-2524","authenticated-orcid":false,"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]},{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"issue":"8","key":"2026101520010440200_dgag219-B1","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1056\/NEJMoa1003466","article-title":"Improved survival with ipilimumab in patients with metastatic melanoma","volume":"363","author":"Hodi","year":"2010","journal-title":"N Engl J Med"},{"issue":"5","key":"2026101520010440200_dgag219-B2","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.2535","article-title":"Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs","volume":"2","author":"Haslam","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2026101520010440200_dgag219-B3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41416-024-02887-1","article-title":"Cancer and treatment specific incidence rates of immune-related adverse events induced by immune checkpoint inhibitors: a systematic review","volume":"132","author":"Jayathilaka","year":"2025","journal-title":"Br J Cancer"},{"key":"2026101520010440200_dgag219-B4","doi-asserted-by":"crossref","first-page":"102536","DOI":"10.1016\/j.eclinm.2024.102536","article-title":"Clinical spectrum and evolution of immune-checkpoint inhibitors toxicities over a decade-a worldwide perspective","volume":"70","author":"Gougis","year":"2024","journal-title":"EClinicalMedicine"},{"issue":"18","key":"2026101520010440200_dgag219-B5","doi-asserted-by":"crossref","first-page":"7503","DOI":"10.1002\/cam4.2661","article-title":"Immune checkpoint inhibitor-associated pituitary-adrenal dysfunction: a systematic review and meta-analysis","volume":"8","author":"Lu","year":"2019","journal-title":"Cancer Med"},{"issue":"2","key":"2026101520010440200_dgag219-B6","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1001\/jamaoncol.2017.3064","article-title":"Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: a systematic review and meta-analysis","volume":"4","author":"Barroso-Sousa","year":"2018","journal-title":"JAMA Oncol"},{"issue":"4","key":"2026101520010440200_dgag219-B7","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1634\/theoncologist.2011-0404","article-title":"Hypophysitis induced by monoclonal antibodies to cytotoxic T lymphocyte antigen 4: challenges from a new cause of a rare disease","volume":"17","author":"Torino","year":"2012","journal-title":"Oncologist"},{"key":"2026101520010440200_dgag219-B8","doi-asserted-by":"crossref","first-page":"1091185","DOI":"10.3389\/fendo.2023.1091185","article-title":"Frequency and clinical characteristics of hypophysitis and hypopituitarism in patients undergoing immunotherapy\u2014a systematic review","volume":"14","author":"Jacques","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"4","key":"2026101520010440200_dgag219-B9","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1210\/jc.2012-4075","article-title":"Endocrine side effects induced by immune checkpoint inhibitors","volume":"98","author":"Corsello","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2026101520010440200_dgag219-B10","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s12020-024-03949-3","article-title":"Immune checkpoint inhibitor-associated new-onset hypophysitis: a retrospective analysis using the FAERS","volume":"86","author":"Lu","year":"2024","journal-title":"Endocrine"},{"issue":"4","key":"2026101520010440200_dgag219-B11","doi-asserted-by":"crossref","first-page":"100683","DOI":"10.1016\/j.modpat.2024.100683","article-title":"Frequency and consequences of immune checkpoint inhibitor-associated inflammatory changes in different organs: an autopsy study over 13 -years","volume":"38","author":"Maccio","year":"2025","journal-title":"Mod Pathol"},{"issue":"7","key":"2026101520010440200_dgag219-B12","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1530\/ERC-20-0513","article-title":"Immune checkpoint inhibitor related hypophysitis: diagnostic criteria and recovery patterns","volume":"28","author":"Nguyen","year":"2021","journal-title":"Endocr Relat Cancer"},{"issue":"4","key":"2026101520010440200_dgag219-B13","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1158\/1078-0432.CCR-14-2353","article-title":"Systemic high-dose corticosteroid treatment does not improve the outcome of ipilimumab-related hypophysitis: a retrospective cohort study","volume":"21","author":"Min","year":"2015","journal-title":"Clin Cancer Res"},{"issue":"6","key":"2026101520010440200_dgag219-B14","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-22-0689","article-title":"Endocrine-related adverse conditions in patients receiving immune checkpoint inhibition: an ESE clinical practice guideline","volume":"187","author":"Husebye","year":"2022","journal-title":"Eur J Endocrinol"},{"issue":"36","key":"2026101520010440200_dgag219-B15","doi-asserted-by":"crossref","first-page":"4073","DOI":"10.1200\/JCO.21.01440","article-title":"Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update","volume":"39","author":"Schneider","year":"2021","journal-title":"J Clin Oncol"},{"issue":"7","key":"2026101520010440200_dgag219-B16","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.eprac.2022.04.010","article-title":"American association of clinical endocrinology disease state clinical review: evaluation and management of immune checkpoint inhibitor-mediated endocrinopathies: a practical case-based clinical approach","volume":"28","author":"Yuen","year":"2022","journal-title":"Endocr Pract"},{"issue":"1","key":"2026101520010440200_dgag219-B17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jpainsymman.2019.03.015","article-title":"Patient-reported outcomes for cancer patients receiving checkpoint inhibitors: opportunities for palliative care-A systematic review","volume":"58","author":"Hall","year":"2019","journal-title":"J Pain Symptom Manage"},{"key":"2026101520010440200_dgag219-B18","doi-asserted-by":"crossref","first-page":"102984","DOI":"10.1016\/j.eclinm.2024.102984","article-title":"Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort study","volume":"79","author":"Lin","year":"2025","journal-title":"EClinicalMedicine"},{"key":"2026101520010440200_dgag219-B19","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ejca.2022.08.029","article-title":"Persistent immune-related adverse events after cessation of checkpoint inhibitor therapy: prevalence and impact on patients\u2019 health-related quality of life","volume":"176","author":"Schulz","year":"2022","journal-title":"Eur J Cancer"},{"issue":"3","key":"2026101520010440200_dgag219-B20","doi-asserted-by":"crossref","first-page":"e1408","DOI":"10.1210\/clinem\/dgaa668","article-title":"Determinants of self-reported health outcomes in adrenal insufficiency: a multisite survey study","volume":"106","author":"Li","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2026101520010440200_dgag219-B21","doi-asserted-by":"crossref","first-page":"G25","DOI":"10.1093\/ejendo\/lvae029","article-title":"European Society of Endocrinology and endocrine society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency","volume":"190","author":"Beuschlein","year":"2024","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2026101520010440200_dgag219-B22","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline","volume":"101","author":"Bornstein","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2026101520010440200_dgag219-B23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav Res Ther"},{"issue":"2","key":"2026101520010440200_dgag219-B24","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1210\/jc.2011-1901","article-title":"Quality of life in European patients with Addison's disease: validity of the disease-specific questionnaire AddiQoL","volume":"97","author":"Oksnes","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2026101520010440200_dgag219-B25","first-page":"1","article-title":"Mice: multivariate imputation by chained equations in R","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"2026101520010440200_dgag219-B26","doi-asserted-by":"crossref","unstructured":"Herndon J, Hleibiehova Y, Achenbach SJ, et al \u00a02026. Data from: determinants of quality of life in patients with immune-checkpoint-inhibitor induced secondary adrenal insufficiency.","DOI":"10.1210\/clinem\/dgag219"},{"issue":"1","key":"2026101520010440200_dgag219-B27","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s11102-021-01182-z","article-title":"Differences between immunotherapy-induced and primary hypophysitis-a multicenter retrospective study","volume":"25","author":"Amereller","year":"2022","journal-title":"Pituitary"},{"issue":"4","key":"2026101520010440200_dgag219-B28","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1136\/jim-2021-002099","article-title":"Immune checkpoint inhibitor-induced hypophysitis: lessons learnt from a large cancer cohort","volume":"70","author":"Kotwal","year":"2022","journal-title":"J Investig Med"},{"issue":"11","key":"2026101520010440200_dgag219-B29","doi-asserted-by":"crossref","first-page":"4078","DOI":"10.1210\/jc.2014-2306","article-title":"Ipilimumab-induced hypophysitis: a detailed longitudinal analysis in a large cohort of patients with metastatic melanoma","volume":"99","author":"Faje","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2026101520010440200_dgag219-B30","doi-asserted-by":"crossref","first-page":"836859","DOI":"10.3389\/fonc.2022.836859","article-title":"Immune checkpoint inhibitor-induced hypophysitis and patterns of loss of pituitary function","volume":"12","author":"Jessel","year":"2022","journal-title":"Front Oncol"},{"issue":"6","key":"2026101520010440200_dgag219-B31","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1080\/17446651.2019.1701434","article-title":"Hypophysitis induced by immune checkpoint inhibitors: a 10-year assessment","volume":"14","author":"Di Dalmazi","year":"2019","journal-title":"Expert Rev Endocrinol Metab"},{"issue":"6","key":"2026101520010440200_dgag219-B32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/MAJ.0b013e3181db6b7a","article-title":"Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients","volume":"339","author":"Bleicken","year":"2010","journal-title":"Am J Med Sci"},{"issue":"3","key":"2026101520010440200_dgag219-B33","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1530\/EJE-09-0884","article-title":"Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies","volume":"162","author":"Hahner","year":"2010","journal-title":"Eur J Endocrinol"},{"issue":"6","key":"2026101520010440200_dgag219-B34","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1530\/EJE-20-1324","article-title":"Characterization of patients with adrenal insufficiency and frequent adrenal crises","volume":"184","author":"Quinkler","year":"2021","journal-title":"Eur J Endocrinol"},{"issue":"5","key":"2026101520010440200_dgag219-B35","doi-asserted-by":"crossref","DOI":"10.1530\/EC-24-0651","article-title":"Factors influencing self-management of adrenal crisis in patients with adrenal insufficiency: a qualitative study","volume":"14","author":"Chua","year":"2025","journal-title":"Endocr Connect"},{"issue":"1","key":"2026101520010440200_dgag219-B36","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.eprac.2021.09.011","article-title":"Secondary adrenal insufficiency: recent updates and new directions for diagnosis and management","volume":"28","author":"Gruber","year":"2022","journal-title":"Endocr Pract"},{"issue":"3","key":"2026101520010440200_dgag219-B37","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S2213-8587(14)70142-1","article-title":"Diagnosis and management of adrenal insufficiency","volume":"3","author":"Bancos","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10274","key":"2026101520010440200_dgag219-B38","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(21)00136-7","article-title":"Adrenal insufficiency","volume":"397","author":"Husebye","year":"2021","journal-title":"Lancet"},{"issue":"5","key":"2026101520010440200_dgag219-B39","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.eprac.2025.02.017","article-title":"People with adrenal insufficiency who are in adrenal crisis are frequently unable to self-administer rescue injections","volume":"31","author":"Hover","year":"2025","journal-title":"Endocr Pract"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgag219\/68430186\/dgag219.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/11\/e2369\/68430186\/dgag219.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/11\/e2369\/68430186\/dgag219.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:01:12Z","timestamp":1792108872000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/111\/11\/e2369\/8697891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgag219","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,5,29]]}}}