Treatment of Adrenal Insufficiency in Patients with Squamous Cell Carcinoma

Diagnosis and Assessment

Adrenal insufficiency in cancer patients may result from bilateral adrenalectomy for management of ectopic Cushing's syndrome, as recommended by the American College of Chest Physicians 2, 3

The American College of Oncology recommends oral hydrocortisone as the drug of choice for long-term management of adrenal insufficiency, with a standard daily dose of 15-25 mg/day in divided doses 1
Higher doses of hydrocortisone, up to 50 mg or more per day, may be required in patients receiving mitotane therapy due to increased metabolic clearance of glucocorticoids, as suggested by the American College of Oncology 1, 5
The American College of Oncology recommends assessing the need for mineralocorticoid replacement (fludrocortisone) based on blood pressure and serum potassium levels 1, 5
The American College of Chest Physicians recommends adjusting glucocorticoid doses during periods of stress, illness, or before chemotherapy 2, 3
The American College of Oncology recommends administering hydrocortisone 150 mg/day during the perioperative period for patients undergoing surgery 6, 7

The American College of Oncology recommends laboratory monitoring, including serum electrolytes, particularly sodium levels, and plasma renin activity if on mineralocorticoid replacement 1, 5
The American College of Oncology also recommends monitoring serum electrolytes, particularly sodium levels 4

Inadequate stress dosing during illness, surgery, or chemotherapy can precipitate adrenal crisis, as warned by the American College of Chest Physicians 2, 3
Overlooking the need for increased glucocorticoid doses in patients receiving mitotane therapy can lead to adrenal insufficiency, as cautioned by the American College of Oncology 1, 5
Misdiagnosing hyponatremia as SIADH when it may be due to adrenal insufficiency can lead to inappropriate treatment, as noted by the American College of Chest Physicians and Praxis Medical Insights 2, 4