Assessment and Investigations

Adrenal crisis, rule out sepsis

Adrenalitis Unlikely

• Random cortisol >160 µg/L

Likely

• Random cortisol <160 µg/L

Management

• Urgent hydrocortisone stress dose of hydrocortisone 100mg IV (or IM)
• Intravenous hydration
• Hold ICPI
• Taper to physiological substitution in consultation with Endocrinology
• Measure renin-aldosterone and start fludrocortisone in consultation with Endocrinology
• Restart ICPI once adequately substituted