Immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have revolutionized cancer therapy, substantially improving survival across a broad range of malignancies. However, these agents are associated with a unique profile of endocrine immune-related adverse events (irAEs), including thyroiditis, hypophysitis, adrenalitis, and pancreatitis, which differ significantly from the toxicities seen with conventional chemotherapy. These complications often arise unpredictably during treatment and may result in irreversible hormone deficiencies requiring lifelong replacement, underscoring the importance of early detection.18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has emerged as a valuable tool not only for oncologic staging and response assessment but also for detecting metabolic changes in endocrine organs. PET/CT can identify irAEs before the appearance of clinical symptoms or biochemical abnormalities. Emerging evidence suggests that the presence of endocrine irAEs identified by18F-FDG PET/CT may correlate with improved treatment response and survival, possibly reflecting enhanced immune activation. This comprehensive review discusses the role of18F-FDG PET/CT in the early recognition of therapy-induced endocrine toxicities, facilitating timely intervention through hormone replacement or immunosuppressive therapy while minimizing unnecessary treatment interruptions. Effective integration of metabolic imaging with clinical and laboratory evaluation requires coordinated multidisciplinary collaboration among oncologists, endocrinologists, and nuclear medicine physicians to optimize outcomes and reduce endocrine-related morbidity in the era of precision oncology.
免疫检查点抑制剂（ICIs）和酪氨酸激酶抑制剂（TKIs）已彻底改变了癌症治疗，显著提高了多种恶性肿瘤患者的生存率。然而，这些药物会引发一系列独特的内分泌免疫相关不良事件（irAEs），包括甲状腺炎、垂体炎、肾上腺炎和胰腺炎，其毒性特征与传统化疗药物显著不同。这些并发症常在治疗过程中不可预测地发生，可能导致不可逆的激素缺乏，需终身替代治疗，因此早期发现至关重要。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）不仅已成为肿瘤分期和疗效评估的重要工具，还能检测内分泌器官的代谢变化。PET/CT可在临床症状或生化异常出现前识别免疫相关不良事件。新近证据表明，通过18F-FDG PET/CT发现的内分泌免疫相关不良事件可能与更好的治疗反应和生存改善相关，这可能反映了免疫活性的增强。本综述全面探讨了18F-FDG PET/CT在早期识别治疗引起的内分泌毒性中的作用，有助于通过激素替代或免疫抑制治疗及时干预，同时最大限度地减少不必要的治疗中断。将代谢成像与临床及实验室评估有效整合，需要肿瘤科医生、内分泌科医生和核医学医师之间的多学科协作，以在精准肿瘤学时代优化治疗结果并降低内分泌相关疾病发病率。
肿瘤(癌症)患者之家