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

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