Immune checkpoint inhibitors (ICI) have become a cornerstone in medical oncology, with evolving therapeutic strategies and applications. These monoclonal antibodies, designed to enhance immune responses, have revealed a spectrum of immune-related adverse events (irAEs). While many irAEs exhibit favorable responses to corticosteroid or immunosuppressive therapy, most ICI-related endocrinopathies necessitate lifelong replacement therapy and pose significant clinical challenges. Adrenal insufficiency (AI), a noteworthy endocrine irAE, can manifest as primary AI (PAI) or secondary AI (SAI), resulting from adrenal or pituitary gland dysfunction, respectively. ICI-induced AI, albeit relatively infrequent, occurs in 1-2% of patients receiving single-agent anti-Programmed Death-1/Programmed Death-Ligand 1 (PD-1/PD-L1) or Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) therapies and in a higher range of 4-9% when ICIs are used in combinations. Recognizing and addressing ICI-induced PAI is crucial, as it often presents with acute and potentially life-threatening symptoms, especially considering the expanding use of ICI therapy. This review provides an updated overview of ICI-induced PAI, exploring its clinical, diagnostic, and radiological aspects.

中文翻译：

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免疫检查点抑制剂引起的原发性肾上腺皮质功能不全：生物学、临床和放射学方面

免疫检查点抑制剂（ICI）已成为医学肿瘤学的基石，其治疗策略和应用不断发展。这些单克隆抗体旨在增强免疫反应，揭示了一系列免疫相关不良事件 (irAE)。虽然许多 irAE 对皮质类固醇或免疫抑制治疗表现出良好的反应，但大多数 ICI 相关内分泌疾病需要终身替代治疗，并带来重大的临床挑战。肾上腺功能不全 (AI) 是一种值得注意的内分泌 irAE，可表现为原发性 AI (PAI) 或继发性 AI (SAI)，分别由肾上腺或垂体功能障碍引起。 ICI 诱导的 AI 虽然相对罕见，但在接受单药抗程序性死亡 1/程序性死亡配体 1 (PD-1/PD-L1) 或细胞毒性 T 淋巴细胞抗原 4 的患者中，有 1-2% 发生（ CTLA-4) 疗法，当 ICI 联合使用时，范围更高，为 4-9%。识别和解决 ICI 诱发的 PAI 至关重要，因为它经常出现急性且可能危及生命的症状，特别是考虑到 ICI 疗法的广泛使用。本综述提供了 ICI 诱发的 PAI 的最新概述，探讨了其临床、诊断和放射学方面。