The adrenal glands are responsible for producing hormones that regulate metabolism, immune response, blood pressure, and stress responses. Adrenal insufficiency is a condition in which the adrenal glands do not produce enough of these certain essential hormones, particularly cortisol, and sometimes aldosterone. There are two main types of adrenal insufficiency:
- Primary adrenal insufficiency: Occurs when the adrenal glands are damaged and cannot produce enough cortisol and aldosterone.
- Secondary adrenal insufficiency: Occurs when the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH), which signals the adrenal glands to produce cortisol.
Prevention of adrenal insufficiency in patients with cancer is challenging, as the condition is often an adverse event of cancer treatment. Abrupt discontinuation of corticosteroids should be avoided and close monitoring of patients receiving ICIs is essential to detect and manage adrenal insufficiency early. Patients should be educated about the signs and symptoms of adrenal insufficiency (listed above) and promptly seek medical attention if they experience any of these symptoms after receiving treatment.
The initial management in patients with cancer typically involves stopping or temporarily suspending the ICI therapy and initiating corticosteroid therapy to address any hormonal deficiencies and to reduce inflammation and further damage to the adrenal glands:
- Hydrocortisone (Cortisone®)
- Prednisone (Deltasone®)
- Dexamethasone (Decadron®)
Mineralocorticoid replacement with fludrocortisone (Florinef®) may also be used to address hormonal deficiencies.
