Medicine Matters oncology

Features: A random cortisol of <100 nmol/L at any time of the day indicates adrenal insufficiency. As biochemical changes can precede physical symptoms with an acute drop in serum cortisol levels, this can be accompanied by with elevated ACTH levels [5].  Symptoms include worsening fatigue, dizziness, arthralgia. 

Investigations: A random cortisol level test, biochemistry, ACTH and short synacthen test (to assess adrenal function). Corticosteroids can suppress adrenal function, thus reducing cortisol levels, and this should be excluded as part of investigations. HCPs should consider checking TFT’s and doing a random glucose test to exclude hypopituitarism.

Management: Replacement with oral hydrocortisone in split doses (10 mg in the morning, 5 mg in the afternoon, and 5 mg in the evening) can alleviate fatigue, arthralgia, and headache, alongside doubling doses of steroid replacement during times of illness commonly termed as “sick day rules”.  Referral to an endocrinologist is recommended for long-term management.