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Adrenal

Dear doctor: This is a patient of esophageal cancer under Pembrolizumab and PF since 2020/12/15. Cortisol level on 12/17 was 1.74ug/dl. However, the patient did not have symptoms suggestive of adrenal insufficiency until days ago when he suffered from shock. He had better appetite today. My opinion is check AM Cortisol and ACTH tomorrow (before 10AM). If cortisol level is still low, you may give him Solu-Cortef 50mg iv stat, than observe the response of blood pressure. If his blood pressure becomes normalized after Solu-Cortef, physical dose supplement of cortisone acetate (25/12.5mg bid) may be necessary. Please contact with me for further management.