摘要目的:分析恶性肿瘤患者应用程序性死亡受体-1(programmed death-1, PD-1)/程序性死亡配体-1(PD-L1)抑制剂治疗出现垂体炎的临床特征，提高对该类疾病的认识。方法:采用回顾性分析的方法，对近3年来收治的18例PD-1/PD-L1抑制剂相关垂体炎的临床表现、实验室检查和影像学特点进行分析。结果:PD-1/PD-L1抑制剂相关垂体炎患者共18例(0.49%，18/3 689)，平均年龄(58.6±10.3)岁，其中男性11例，女性7例；信迪利单抗和帕博利珠单抗各6例、度伐利尤单抗3例，占83.3%(15/18)。垂体炎的中位确诊时间为用药后5.9(3.5，9.6)个月，且发生时间与PD-1/PD-L1抑制剂种类有关。主要的临床表现为乏力、纳差、恶心等(72.2%, 13/18)，有4例患者发生昏迷，15例发生低钠血症(83.3%)。腺垂体受累激素中，促肾上腺皮质激素(ACTH)缺乏、促甲状腺素(TSH)缺乏、促性腺激素缺乏、生长激素(GH)缺乏和高催乳素血症的发生率分别为100%、27.8%、16.7%、11.1%和44.4%；垂体后叶均未受累。男性和女性垂体炎患者上述特征无统计学差异。有53.3%患者垂体磁共振成像(MRI)未见异常，其余为轻度异常；均无垂体增大；有5例患者合并甲状腺受累，2例合并胰岛损害；免疫相关性不良反应(irAEs)经不良反应通用术语标准(CTCAE)分级3级及以上的有4例(22.2%)，其余患者属于CTCAE 1～2级。结论:当PD-1/PD-L1抑制剂治疗患者出现乏力、纳差、低血钠等情况，需警惕药物相关垂体炎的可能性。PD-1/PD-L1抑制剂所致垂体炎最易受累的是垂体前叶激素及ACTH减低，后叶不易损害，垂体无明显增大，生理剂量糖皮质激素可有效缓解症状。

abstractsObjective:To analyze the clinical characteristics of programmed death-1(PD-1)/programmed death-ligand 1(PD-L1) inhibitors-induced hypophysitis in patients with malignant tumors, and to improve the understanding of this disease.Methods:The clinical manifestations, laboratory tests, and imaging features of 18 cases of PD-1/PD-L1 inhibitors-related hypophysitis cases treated in recent 3 years were analyzed retrospectively.Results:Among the 18 patients(0.49%, 18/3 689) with PD-1/PD-L1 inhibitors-associated hypophysitis, there were 11 males and 7 females, with the average age of(58.6±10.3) years old. There were 6 cases treated with Sindilizumab, 6 cases of Pabolizumab, and 3 cases of Duvaliumab, acounting for 83.3%(15/18). The median time to diagnosis of hypophysitis was 5.9(3.5, 9.6)months, which was related to the type of PD-1/PD-L1 inhibitors. The main clinical manifestations were fatigue, poor appetite, nausea(72.2%, 13/18), with 4 patients experiencing coma and 15 cases of hyponatremia(83.3%). The incidence of adrenocorticotropic hormone(ACTH) deficiency, thyroid stimulating hormone(TSH) deficiency, gonadotropins deficiency, growth hormone(GH) deficiency and hyperprolactinemia were 100%, 27.8%, 16.7%, 11.1% and 44.4%, respectively. No posterior pituitary was involved. There was no statistical difference between male and female patients with pituitary inflammation. 53.3% of the patients had no abnormal pituitary magnetic resonance imaging(MRI), and the rest were mildly abnormal, without pituitary enlargement. There were 5 patients with primary thyroid involvement and 2 patients with damaged pancreas. Four cases (22.2%) of immune-related reactions (irAEs) were grade 3 and above according to the Common Terminology Criteria for adverse Events (cTCAE), and the rest of the patients were CTCAE grade 1-2.Conclusion:When patients receiving PD-1/PD-L1 inhibitors present with symptoms such as fatigue, poor appetite, and hyponatremia, caution should be exercised for the possibility of drug-related hypophysitis. Hypophysitis induced by PD-1/PD-L1 inhibitors primarily affects the anterior pituitary lobe with a decrease in ACTH hormone levels, while the posterior lobe is less affected, and there is no significant enlargement of the pituitary gland. Physiological doses of glucocorticoids can effectively alleviate symptoms.