SUN-016 Determinants Of Quality Of Life In Patients With Immune-checkpoint-inhibitor Induced Adrenal Insufficiency

Abstract Disclosure: J. Herndon: None. Y. Hleibiehova: None. A. Bancos: None. S. Achenbach: None. E. Atkinson: None. D. Donegan: Camarus, Recordati. I. Bancos: None. Introduction: Studies show that quality of life (QOL) among patients with adrenal insufficiency (AI) (primary (PAI) or secondary (SAI)) improves following adequate glucocorticoid replacement, however decreased QOL persists. SAI due to hypophysitis or infrequently PAI due to adrenalitis are recognized complications of immune-checkpoint-inhibitors (ICI). It is unknown if patients with ICI induced AI (ICI-AI) would report similar findings in QOL. Aim: To assess the impact of ICI-AI on specific determinants of health-related QOL (HRQOL) and compare management and outcomes to SAI due to other etiologies (oSAI). Methods: A cross-sectional survey study of adult patients who completed at least 1 AddiQOL survey with a diagnosis of ICI- AI or oSAI evaluated between 2015 and 2024 were included. Patients with opioid- or glucocorticoid-induced-AI were excluded. A study survey obtained information regarding diagnosis and treatment. Results: 112 patients with ICI-AI were included (SAI n=109, PAI n=3). Among those with ICI-AI, 59% were female, median age at diagnosis was 59.7 ±12.8 years and melanoma was the most common indication for ICI use (51%). The median time to ICI-AI diagnosis was 5.5 (range 0.3-80.8) months and 46% used combination ICI therapy. When compared to those with oSAI (n=139), patients with central ICI-AI were older at diagnosis (59 ±12.7 vs 46 ±18.1 years, p <0.01), more were female (59 vs 43%, p=0.015) and most were diagnosed in the last year (88% vs 42%, p<0.01). Those with ICI-AI received higher hydrocortisone (HC) equivalent daily doses than those with oSAI (25.1± 18.3 vs 22.1 ±16.9 mg/day, p<0.01), however there was no difference in the number of adrenal crises (AC) reported within the last year (14 vs 16, p=0.78). Patients with ICI-AI felt that emergency personnel understood their diagnosis and treated them promptly (75% vs 0% p=0.012). Logistic regression analysis of the entire group (ICI-AI + oSAI) did not identify an association between the occurrence of AC in the last year and HC dose >20 mg/day or type of glucocorticoid. Furthermore, there was no difference in number of AC per person year assessed between the ICI-AI and oSAI (0.23 ±0.5 vs 0.21 ±0.5, p= 0.4). The mean total AddiQOL score was higher in those with ICI-AI (87.2 ±13.9 vs 81.8 ±15.8, p=0.02). When adjusted for age and sex, total AddiQOL score was inversely related to number of symptoms present (r: -0.49, p<0.01; r: -0.58, p<0.01), occurrence of AC in the last year (r: -0.27, p=0.01; r: -0.33, p<0.01) and positively related to current employment (r:0.33 p<0.01 0.2,p=0.02) in ICI-AI and oSAI respectively. Conclusion: This is the first study to compare management and HRQOL in patients with ICI-AI compared to oSAI and although there were no significant differences in total number of AC events between the 2 groups, differences exist in terms of AI presentation, management and reported QOL. Presentation: Sunday, July 13, 2025