{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:52:14Z","timestamp":1789537934823,"version":"build-2803163510"},"reference-count":103,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Immune-mediated hypophysitis comprises a heterogeneous group of inflammatory pituitary disorders, including primary lymphocytic hypophysitis, immune checkpoint inhibitor (ICI)-induced hypophysitis, IgG4-related hypophysitis, and paraneoplastic autoimmune hypophysitis. Although these entities share immune-mediated mechanisms, they differ substantially in clinical presentation, imaging features, and therapeutic implications. Methods: This narrative review synthesizes current evidence on the pathophysiology, clinical manifestations, radiological characteristics, diagnostic approach, and management of immune-mediated hypophysitis, with particular emphasis on etiological heterogeneity. Results: Hypopituitarism\u2014particularly ACTH deficiency\u2014is the most frequent and clinically relevant manifestation, as secondary adrenal insufficiency may be life-threatening if not promptly recognized and treated. It is often accompanied by headache, arginine vasopressin deficiency, or mass effect depending on the subtype. Magnetic resonance imaging typically shows symmetrical pituitary enlargement and stalk thickening in inflammatory forms, although findings vary according to etiology and may be minimal in certain subtypes such as PD-1\/PD-L1 inhibitor-associated hypophysitis. Distinct clinical phenotypes are observed across subtypes, particularly in ICI-induced hypophysitis and IgG4-related disease. Diagnosis relies on the integration of endocrine, radiological, and clinical features, supported by clinicoradiological scoring systems in selected cases. Management is primarily based on prompt hormone replacement, with selective use of glucocorticoids or immunosuppressive therapies depending on disease severity and underlying etiology. Conclusions: Immune-mediated hypophysitis represents a clinically relevant and increasingly recognized spectrum of disorders requiring a multidisciplinary and etiology-specific approach. Early recognition is essential to prevent life-threatening endocrine complications. Advances in the understanding of immunopathogenic mechanisms and the identification of reliable biomarkers may enable earlier diagnosis and more personalized therapeutic strategies.<\/jats:p>","DOI":"10.3390\/jcm15093313","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3313","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Immune-Mediated Hypophysitis: An Updated Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0126-1985","authenticated-orcid":false,"given":"Pedro","family":"Iglesias","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Segovia de Arana, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"R151","DOI":"10.1530\/EJE-17-0009","article-title":"MECHANISMS IN ENDOCRINOLOGY: Hypophysitis: Diagnosis and Treatment","volume":"179","author":"Joshi","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101371","DOI":"10.1016\/j.beem.2019.101371","article-title":"Hypophysitis: An Update on the Novel Forms, Diagnosis and Management of Disorders of Pituitary Inflammation","volume":"33","author":"Gubbi","year":"2019","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.eprac.2022.06.009","article-title":"Hypophysitis","volume":"28","author":"Donegan","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_4","first-page":"116","article-title":"Executive Summary of the Consensus Document on Hypophysitis of the Neuroendocrinology Area of Knowledge of the Spanish Society of Endocrinology and Nutrition","volume":"70","author":"Iglesias","year":"2023","journal-title":"Endocrinol. Diabetes Nutr. (Engl. Ed.)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1038\/s41574-025-01200-1","article-title":"An Update on Hypophysitis","volume":"22","author":"Miquel","year":"2025","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1767","DOI":"10.1210\/clinem\/dgae664","article-title":"Deciphering the Presentation and Etiologies of Hypophysitis Highlights the Need for Repeated Systematical Investigation","volume":"110","author":"Miquel","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Di Stasi, V., La Sala, D., Cozzi, R., Scavuzzo, F., De Geronimo, V., Poggi, M., Vitale, M., and Tortora, A. (2025). Immunotherapy-Related Hypophysitis: A Narrative Review. Cancers, 17.","DOI":"10.3390\/cancers17030436"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.ecl.2025.06.009","article-title":"Hypophysitis Associated with Immune Checkpoint Inhibitors","volume":"54","author":"Corsello","year":"2025","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_9","first-page":"e98717","article-title":"Immune Checkpoint Inhibitor-Related Hypophysitis and Pituitary Dysfunction: A Systematic Review of Diagnosis and Management","volume":"17","author":"SirDeshpande","year":"2025","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1210\/clinem\/dgab672","article-title":"Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease","volume":"107","author":"Langlois","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.arcmed.2022.01.003","article-title":"Neuroendocrine-Immune Interface: Interactions of Two Complex Systems in Health and Disease","volume":"53","author":"Salazar","year":"2022","journal-title":"Arch. Med. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1056\/NEJM199505183322008","article-title":"The Hypothalamic-Pituitary-Adrenal Axis and Immune-Mediated Inflammation","volume":"332","author":"Chrousos","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"115227","DOI":"10.1016\/j.celrep.2024.115227","article-title":"Early Precursor-Derived Pituitary Gland Tissue-Resident Macrophages Play a Pivotal Role in Modulating Hormonal Balance","volume":"44","author":"Lehtonen","year":"2025","journal-title":"Cell Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.1999.79.1.1","article-title":"Regulation of the Hypothalamic-Pituitary-Adrenal Axis by Cytokines: Actions and Mechanisms of Action","volume":"79","author":"Turnbull","year":"1999","journal-title":"Physiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1365-2567.2004.01821.x","article-title":"Factors Affecting the Susceptibility of the Mouse Pituitary Gland to CD8 T-Cell-Mediated Autoimmunity","volume":"111","author":"Carmignac","year":"2004","journal-title":"Immunology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.bbi.2015.07.007","article-title":"Pituitary Dendritic Cells Communicate Immune Pathogenic Signals","volume":"50","author":"Glennon","year":"2015","journal-title":"Brain Behav. Immun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1053\/beem.1999.0041","article-title":"Regulation of the Hypothalamo-Pituitary-Adrenal Axis by Cytokines","volume":"13","author":"Mulla","year":"1999","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yan, T., Wang, R., Yao, J., and Luo, M. (2023). Single-Cell Transcriptomic Analysis Reveals Rich Pituitary-Immune Interactions under Systemic Inflammation. PLoS Biol., 21.","DOI":"10.1371\/journal.pbio.3002403"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/17446651.2019.1598260","article-title":"Hypophysitis in the Era of Immune Checkpoint Inhibitors and Immunoglobulin G4-Related Disease","volume":"14","author":"Wehbeh","year":"2019","journal-title":"Expert. Rev. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5496","DOI":"10.1210\/en.2005-0409","article-title":"Involvement of Corticotropin-Releasing Hormone- and Interleukin (IL)-6-Dependent Proopiomelanocortin Induction in the Anterior Pituitary during Hypothalamic-Pituitary-Adrenal Axis Activation by IL-1alpha","volume":"146","author":"Chida","year":"2005","journal-title":"Endocrinology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.4049\/jimmunol.2001073","article-title":"Th17 Cells Contribute to the Pathology of Autoimmune Hypophysitis","volume":"206","author":"Chalan","year":"2021","journal-title":"J. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1507\/endocrj.EJ20-0436","article-title":"Anti-Pituitary Antibodies as a Marker of Autoimmunity in Pituitary Glands","volume":"67","author":"Iwama","year":"2020","journal-title":"Endocr. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"230ra45","DOI":"10.1126\/scitranslmed.3008002","article-title":"Pituitary Expression of CTLA-4 Mediates Hypophysitis Secondary to Administration of CTLA-4 Blocking Antibody","volume":"6","author":"Iwama","year":"2014","journal-title":"Sci. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11102-015-0671-4","article-title":"Immunotherapy and Hypophysitis: Clinical Presentation, Treatment, and Biologic Insights","volume":"19","author":"Faje","year":"2016","journal-title":"Pituitary"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1159\/000506903","article-title":"Hypophysitis (Including IgG4 and Immunotherapy)","volume":"110","author":"Angelousi","year":"2020","journal-title":"Neuroendocrinology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1007\/s00701-022-05231-9","article-title":"IgG4-Related Hypophysitis: A Retrospective Cohort Study","volume":"164","author":"Bhargava","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101601","DOI":"10.1016\/j.beem.2021.101601","article-title":"Paraneoplastic Autoimmune Hypophysitis: An Emerging Concept","volume":"36","author":"Bando","year":"2022","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_28","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":"ref_29","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1507\/endocrj.EJ23-0050","article-title":"Paraneoplastic Autoimmune Hypophysitis: A Novel Form of Paraneoplastic Endocrine Syndrome","volume":"70","author":"Takahashi","year":"2023","journal-title":"Endocr. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1365-2265.2009.03765.x","article-title":"How Reliably Can Autoimmune Hypophysitis Be Diagnosed without Pituitary Biopsy","volume":"73","author":"Howlett","year":"2010","journal-title":"Clin. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s11102-021-01180-1","article-title":"Typing of Inflammatory Lesions of the Pituitary","volume":"25","author":"Warmbier","year":"2022","journal-title":"Pituitary"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s11604-023-01417-y","article-title":"Neuroimaging of Hypophysitis: Etiologies and Imaging Mimics","volume":"41","author":"Kurokawa","year":"2023","journal-title":"Jpn. J. Radiol."},{"key":"ref_33","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":"Barry","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1530\/EJE-14-0845","article-title":"Long-Term Follow-up of Ipilimumab-Induced Hypophysitis, a Common Adverse Event of the Anti-CTLA-4 Antibody in Melanoma","volume":"172","author":"Albarel","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/bpa.12459","article-title":"IgG4-Related Hypophysitis Is Highly Prevalent among Cases of Histologically Confirmed Hypophysitis","volume":"27","author":"Bernreuther","year":"2017","journal-title":"Brain Pathol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"K1","DOI":"10.1093\/ejendo\/lvad179","article-title":"Clinical Features of Anti-Pituitary-Specific Transcription Factor-1 (PIT-1) Hypophysitis: A New Aspect of Paraneoplastic Autoimmune Condition","volume":"190","author":"Urai","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"47","DOI":"10.20945\/2359-3997000000102","article-title":"Clinical and Hormonal Characteristics of Patients with Different Types of Hypophysitis: A Single-Center Experience","volume":"63","author":"Imga","year":"2019","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e240223","DOI":"10.1530\/EC-24-0223","article-title":"Immune Checkpoint Inhibitor Induced Hypophysitis: A Specific Disease of Corticotrophs?","volume":"13","author":"Patel","year":"2024","journal-title":"Endocr. Connect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e000779","DOI":"10.1136\/jitc-2020-000779","article-title":"Pituitary Dysfunction Induced by Immune Checkpoint Inhibitors Is Associated with Better Overall Survival in Both Malignant Melanoma and Non-Small Cell Lung Carcinoma: A Prospective Study","volume":"8","author":"Kobayashi","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1530\/EJE-13-0642","article-title":"The Prevalence of IgG4-Related Hypophysitis in 170 Consecutive Patients with Hypopituitarism and\/or Central Diabetes Insipidus and Review of the Literature","volume":"170","author":"Bando","year":"2014","journal-title":"Eur. J. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1210\/er.2004-0011","article-title":"Autoimmune Hypophysitis","volume":"26","author":"Caturegli","year":"2005","journal-title":"Endocr. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3225","DOI":"10.1016\/j.ajpath.2016.08.020","article-title":"Hypophysitis Secondary to Cytotoxic T-Lymphocyte-Associated Protein 4 Blockade: Insights into Pathogenesis from an Autopsy Series","volume":"186","author":"Caturegli","year":"2016","journal-title":"Am. J. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e002493","DOI":"10.1136\/jitc-2021-002493","article-title":"Anti-Pituitary Antibodies and Susceptible Human Leukocyte Antigen Alleles as Predictive Biomarkers for Pituitary Dysfunction Induced by Immune Checkpoint Inhibitors","volume":"9","author":"Kobayashi","year":"2021","journal-title":"J. Immunother. Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1530\/ERC-21-0228","article-title":"Immunotherapy-Induced Isolated ACTH Deficiency in Cancer Therapy","volume":"28","author":"Iglesias","year":"2021","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1007\/s11102-021-01141-8","article-title":"Isolated ACTH Deficiency Induced by Cancer Immunotherapy: A Systematic Review","volume":"24","author":"Iglesias","year":"2021","journal-title":"Pituitary"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S1474-4422(17)30471-4","article-title":"IgG4-Related Disease of the Central and Peripheral Nervous Systems","volume":"17","author":"AbdelRazek","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1056\/NEJMra1104650","article-title":"IgG4-Related Disease","volume":"366","author":"Stone","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1016\/S0140-6736(14)60720-0","article-title":"IgG4-Related Disease","volume":"385","author":"Kamisawa","year":"2015","journal-title":"Lancet"},{"key":"ref_49","first-page":"565","article-title":"IgG4-Related Disease: A Systemic Condition with Characteristic Microscopic Features","volume":"28","author":"Detlefsen","year":"2013","journal-title":"Histol. Histopathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1038\/s41577-023-00871-z","article-title":"The Unique Properties of IgG4 and Its Roles in Health and Disease","volume":"23","author":"Rispens","year":"2023","journal-title":"Nat. Rev. Immunol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"101663","DOI":"10.1016\/j.beem.2022.101663","article-title":"The Novel Concept of \u201cOnco-Immuno-Endocrinology\u201d Led to the Discovery of New Clinical Entity \u201cParaneoplastic Autoimmune Hypophysitis\u201d","volume":"36","author":"Takahashi","year":"2022","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"bnz003","DOI":"10.1210\/endrev\/bnz003","article-title":"Autoimmune Pituitary Disease: New Concepts with Clinical Implications","volume":"41","author":"Yamamoto","year":"2020","journal-title":"Endocr. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"7900","DOI":"10.1038\/s41467-025-63183-x","article-title":"Modeling of T Cell-Mediated Autoimmune Pituitary Disease Using Human Induced Pluripotent Stem Cell-Originated Organoid","volume":"16","author":"Kanie","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"43060","DOI":"10.1038\/srep43060","article-title":"A Novel Thymoma-Associated Autoimmune Disease: Anti-PIT-1 Antibody Syndrome","volume":"7","author":"Bando","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.1007\/s00262-021-02955-y","article-title":"Mechanistic Insights into Immune Checkpoint Inhibitor-Related Hypophysitis: A Form of Paraneoplastic Syndrome","volume":"70","author":"Kanie","year":"2021","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/jnen\/nlaf135","article-title":"Primary Hypophysitis: Classification Review","volume":"85","author":"Turin","year":"2026","journal-title":"J. Neuropathol. Exp. Neurol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/cen.13354","article-title":"Primary Lymphocytic Hypophysitis: Clinical Characteristics and Treatment of 50 Cases in a Single Centre in China over 18 Years","volume":"87","author":"Wang","year":"2017","journal-title":"Clin. Endocrinol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s004010000288","article-title":"Severe Lymphocytic Adenohypophysitis with Selective Disappearance of Prolactin Cells: A Histologic, Ultrastructural and Immunoelectron Microscopic Study","volume":"101","author":"Horvath","year":"2001","journal-title":"Acta Neuropathol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1056\/NEJM199309023291002","article-title":"Lymphocytic Infundibuloneurohypophysitis as a Cause of Central Diabetes Insipidus","volume":"329","author":"Imura","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e12954","DOI":"10.1111\/jne.12954","article-title":"Diabetes Insipidus Secondary to Sellar\/Parasellar Lesions","volume":"33","author":"Angelousi","year":"2021","journal-title":"J. Neuroendocrinol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1093\/ejendo\/lvae101","article-title":"Evaluation and Follow-up of Patients Diagnosed with Hypophysitis: A Cohort Study","volume":"191","author":"Hacioglu","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/00005792-198907000-00006","article-title":"Lymphocytic Hypophysitis. Report of 3 New Cases and Review of the Literature","volume":"68","author":"Cosman","year":"1989","journal-title":"Medicine"},{"key":"ref_63","first-page":"2302","article-title":"Clinical Case Seminar: Lymphocytic Hypophysitis: Clinicopathological Findings","volume":"80","author":"Thodou","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11102-006-6598-z","article-title":"Lymphocytic Hypophysitis: Disease Spectrum and Approach to Diagnosis and Therapy","volume":"9","author":"Rivera","year":"2006","journal-title":"Pituitary"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"4190","DOI":"10.1210\/en.2011-1004","article-title":"From Pituitary Expansion to Empty Sella: Disease Progression in a Mouse Model of Autoimmune Hypophysitis","volume":"152","author":"Lupi","year":"2011","journal-title":"Endocrinology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"865","DOI":"10.2169\/internalmedicine.38.865","article-title":"Spontaneous Recovery from Pathologically Confirmed Lymphocytic Adenohypophysitis with a Dramatic Reduction of Hypophyseal Size","volume":"38","author":"Yamakita","year":"1999","journal-title":"Intern. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s11102-013-0510-4","article-title":"Idiopathic Granulomatous Hypophysitis: A Systematic Review of 82 Cases in the Literature","volume":"17","author":"Hunn","year":"2014","journal-title":"Pituitary"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1111\/apm.12603","article-title":"Granulomatous and Lymphocytic Hypophysitis\u2014Are They Immunologically Distinct?","volume":"124","author":"Rao","year":"2016","journal-title":"APMIS"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3841","DOI":"10.1210\/jc.2015-2152","article-title":"Diagnosis of Primary Hypophysitis in Germany","volume":"100","author":"Honegger","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3803\/EnM.2025.2477","article-title":"Immune Checkpoint Inhibitor-Related Hypophysitis: A Call for Vigilance","volume":"40","author":"Lee","year":"2025","journal-title":"Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3803\/EnM.2024.2180","article-title":"Combined PD-1 and CTLA-4 Blockade Increases the Risks of Multiple Pituitary Hormone Deficiency and Isolated Adrenocorticotropic Deficiency: A Prospective Study","volume":"40","author":"Iwama","year":"2025","journal-title":"Endocrinol. Metab."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1507\/endocrj.EJ25-0129","article-title":"Histologically Confirmed Immunoglobulin G4-Related Hypophysitis in an Adolescent Girl: A Case Report with Review of Literature","volume":"72","author":"Shimizu","year":"2025","journal-title":"Endocr. J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1148\/radiology.195.1.7892490","article-title":"Lymphocytic Adenohypophysitis: Contrast-Enhanced MR Imaging in Five Cases","volume":"195","author":"Ahmadi","year":"1995","journal-title":"Radiology"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.3174\/ajnr.A2201","article-title":"Parasellar T2 Dark Sign on MR Imaging in Patients with Lymphocytic Hypophysitis","volume":"31","author":"Nakata","year":"2010","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3877","DOI":"10.1210\/jc.2018-01021","article-title":"Hypophysitis Outcome and Factors Predicting Responsiveness to Glucocorticoid Therapy: A Prospective and Double-Arm Study","volume":"103","author":"Chiloiro","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.crad.2020.12.028","article-title":"The Imaging of Immunotherapy-Related Hypophysitis and Other Pituitary Lesions in Oncology Patients","volume":"76","author":"Lasocki","year":"2021","journal-title":"Clin. Radiol."},{"key":"ref_77","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."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"281","DOI":"10.6004\/jnccn.2022.7098","article-title":"Hypophysitis and Secondary Adrenal Insufficiency from Immune Checkpoint Inhibitors: Diagnostic Challenges and Link with Survival","volume":"21","author":"Johnson","year":"2023","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1530\/EJE-19-0238","article-title":"Hypophysitis Secondary to Nivolumab and Pembrolizumab Is a Clinical Entity Distinct from Ipilimumab-Associated Hypophysitis","volume":"181","author":"Faje","year":"2019","journal-title":"Eur. J. Endocrinol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e70116","DOI":"10.1111\/jne.70116","article-title":"Magnetic Resonance Imaging Features of Hypophysitis in Patients with Cancer Treated with Immune Checkpoint Inhibitors","volume":"38","author":"Angelousi","year":"2026","journal-title":"J. Neuroendocrinol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.3174\/ajnr.A3147","article-title":"MR Imaging of IgG4-Related Disease in the Head and Neck and Brain","volume":"33","author":"Toyoda","year":"2012","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1148\/rg.327125032","article-title":"IgG4-Related Disease of the Head and Neck: CT and MR Imaging Manifestations","volume":"32","author":"Fujita","year":"2012","journal-title":"Radiographics"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Iglesias, P. (2024). An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206161"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"2632","DOI":"10.1016\/S0140-6736(24)00342-8","article-title":"Hypopituitarism","volume":"403","author":"Fleseriu","year":"2024","journal-title":"Lancet"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s11102-022-01232-0","article-title":"Preoperative Differentiation of Hypophysitis and Pituitary Adenomas Using a Novel Clinicoradiologic Scoring System","volume":"25","author":"Wright","year":"2022","journal-title":"Pituitary"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.3174\/ajnr.A1714","article-title":"A Radiologic Score to Distinguish Autoimmune Hypophysitis from Nonsecreting Pituitary Adenoma Preoperatively","volume":"30","author":"Gutenberg","year":"2009","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Taieb, A., Bouzaouache, I., Gasmi, A., Ghachem, A., Halloul, I., Saafi, W., Hamza, E., Ghada, S., Hasni, Y., and Mhabrech, H. (2025). A Predictive Score Incorporating Clinical, Radiologic, and Hormonal Parameters to Discriminate Lymphocytic Hypophysitis from Non-Functioning Pituitary Macroadenomas. Diagnostics, 15.","DOI":"10.3390\/diagnostics15182334"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"m1067","DOI":"10.1136\/bmj.m1067","article-title":"Advances in the Diagnosis and Management of IgG4 Related Disease","volume":"369","author":"Lanzillotta","year":"2020","journal-title":"BMJ"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e6934","DOI":"10.1097\/MD.0000000000006934","article-title":"Rituximab Was Used to Treat Recurrent IgG4-Related Hypophysitis with Ophthalmopathy as the Initial Presentation: A Case Report and Literature Review","volume":"96","author":"Gu","year":"2017","journal-title":"Medicine"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1055\/s-0037-1604079","article-title":"Lymphocytic Hypophysitis Successfully Treated with Stereotactic Radiosurgery: Case Report and Review of the Literature","volume":"79","author":"Pekic","year":"2018","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3171\/2009.6.JNS081176","article-title":"Gamma Knife Surgery for Lymphocytic Hypophysitis","volume":"112","author":"Ray","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s11102-016-0769-3","article-title":"Lymphocytic Hypophysitis: Modern Day Management with Limited Role for Surgery","volume":"20","author":"Kyriacou","year":"2017","journal-title":"Pituitary"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1210\/clinem\/dgab839","article-title":"Outcomes of Initial Management Strategies in Patients with Autoimmune Lymphocytic Hypophysitis: A Systematic Review and Meta-Analysis","volume":"107","author":"Donegan","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s12020-021-02612-5","article-title":"Markers of Humoral and Cell-Mediated Immune Response in Primary Autoimmune Hypophysitis: A Pilot Study","volume":"73","author":"Chiloiro","year":"2021","journal-title":"Endocrine"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"3684","DOI":"10.1210\/jc.2012-2269","article-title":"Involvement of Hypothalamus Autoimmunity in Patients with Autoimmune Hypopituitarism: Role of Antibodies to Hypothalamic Cells","volume":"97","author":"Sinisi","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s12020-023-03394-8","article-title":"Clinical Characteristics and Human Leukocyte Antigens in Patients with Immune Checkpoint Inhibitor-Induced Type 1 Diabetes and Pituitary Dysfunction: A Single Center Prospective Study","volume":"81","author":"Hara","year":"2023","journal-title":"Endocrine"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1158\/2326-6066.CIR-25-0693","article-title":"Concurrent Pituitary and Thyroid Immune-Related Adverse Events after Immune Checkpoint Inhibitors Associated with HLA-DR15-Related Haplotypes","volume":"14","author":"Kobayashi","year":"2026","journal-title":"Cancer Immunol. Res."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ejca.2020.02.049","article-title":"Human Leucocyte Antigen DR15, a Possible Predictive Marker for Immune Checkpoint Inhibitor-Induced Secondary Adrenal Insufficiency","volume":"130","author":"Yano","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Shalit, A., Sarantis, P., Koustas, E., Trifylli, E.-M., Matthaios, D., and Karamouzis, M.V. (2023). Predictive Biomarkers for Immune-Related Endocrinopathies Following Immune Checkpoint Inhibitors Treatment. Cancers, 15.","DOI":"10.3390\/cancers15020375"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"22246","DOI":"10.1073\/pnas.1908079116","article-title":"Autoimmune Antibodies Correlate with Immune Checkpoint Therapy-Induced Toxicities","volume":"116","author":"Tahir","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e656","DOI":"10.1097\/RLU.0000000000005440","article-title":"18 F-FDG PET\/CT for Detection of Immunotherapy-Induced Hypophysitis-A Case-Control Study","volume":"49","author":"Fischer","year":"2024","journal-title":"Clin. Nucl. Med."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Galligan, A., Iravani, A., Lasocki, A., Wallace, R., Weppler, A.M., Sachithanandan, N., Chiang, C., Colman, P.G., Wentworth, J., and Spain, L. (2023). Imaging for Assessment of Cancer Treatment Response to Immune Checkpoint Inhibitors Can Be Complementary in Identifying Hypophysitis. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1295865"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ejim.2019.08.008","article-title":"The Pituitary in Nuclear Medicine Imaging","volume":"68","author":"Iglesias","year":"2019","journal-title":"Eur. J. Intern. 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