Endocrine Adrenalitis
May 18, 2025Pneumonitis
May 18, 2025Endocrine
Hypophysitis
Silent Hypophysitis
Assessment and Investigations
Hypophysitis Unlikely
- 8 am or random cortisol >160 µg/L
Possible
- 8 am cortisol 70-160 µg/L
- Or random cortisol 30-160 µg/L
Likely
- 8 am cortisol <70 µg/L
- Or random cortisol <30 µg/L
Management
- Await hormonal assessment (<24h)
- Start physiological substitution with hydrocortisone 10-5-5mg if hypophysitis possible or likely
- Continue ICPI once adequately substituted
Severe
Assessment and Investigations
Adrenal crisis, rule out sepsis
Adrenalitis Unlikely
-Random cortisol >160 µg/L
Likely
-Random cortisol <160 µg/Ls indicated
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