Immune-Related Endocrine Adverse Events from Checkpoint Inhibitors: A Systematic Review of Clinical Outcomes and Management

Introduction: Immune checkpoint inhibitors (ICIs) improve survival across multiple malignancies but frequently trigger immune-related endocrine adverse events (irEA-E), which can be irreversible and under-recognized.

Methodology: A structured review of randomized trials, cohort studies, and meta-analyses published between 2018 and 2025 was conducted to evaluate endocrine toxicities associated with anti-PD-1/PD-L1 and anti-CTLA-4 agents. Reported outcomes included incidence, timing, reversibility, and management strategies.

Results: Thyroid dysfunction (5–20%) was the most frequently reported endocrine toxicity, followed by hypophysitis (1–15%), adrenal insufficiency (0.5–2%), and autoimmune diabetes (0.2–1.5%). Onset typically occurs weeks to months after therapy initiation. Most events are permanent and require long-term hormone replacement. High-dose corticosteroids are generally reserved for mass-effect hypophysitis or systemic grade ≥3 immune-related adverse events.

Conclusion: Immune-related endocrine adverse events are common and clinically significant complications of immune checkpoint inhibitor therapy. Standardized hormonal screening and multidisciplinary management enable continuation of immunotherapy while minimizing long-term morbidity.

Conflict of interests: The authors declare no conflict of interest.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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