Assessment and Investigations

Hypophysitis Unlikely

• Random cortisol >160 µg/L

Likely

• Random cortisol <160 µg/L

Rule out mass-effect symptoms of hypophysitis, adrenal crisis, rule out sepsis
Perform MRI of the pituitary gland + whole brain imaging (exclude metastasis)

Management

• Urgent hydrocortisone stress dose of hydrocortisone 100mg IV (or IM)
• Intravenous hydration
• Hold ICPI
• Taper to physiological hydrocortisone substitution in consultation with Endocrinology
• If low fT4 and low/normal TSH, first await 72h of hydrocortisone substitution before starting thyroxine replacement therapy
• Restart ICPI once adequately substituted