Table 2.

Electrolytes and hormones at presentation of adrenal insufficiency.

	Cycle 5 week 1a	Febrile neutropeniab	Stress dose hydrocortisonec	Hydrocortisone reducedd	Hydrocortisone restored	Reference range
Days since start of cycle 5	0	14	16	28	30
Sodium	125	124	137	125	137	135–145 mmol/L
Potassium	4.4	4.1	4.4	4.4	3.8	3.5–5.2 mmol/L
Chloride	91	94	104	88	107	95–110 mmol/L
pH	7.39	7.41	7.38			7.36–7.44
Magnesium	0.57	0.58	0.77			0.7–1.0 mmol/L
Renin		4	3	4	94	9–34 U/L
Aldosterone			74			140–2200 pmol/L
ACTH				133		2–11 pmol/L

^aRoutine blood tests before cycle 5 of chemotherapy show hypochloremic hyponatremia with hypomagnesemia. Cisplatin-induced renal salt wasting was considered; ^bPatient developed febrile neutropenia and stress dose hydrocortisone was started; ^cElectrolytes improve following treatment with stress dose hydrocortisone; ^dPatient was readmitted with fatigue and hyperpigmentation following attempt to reduce the dose of hydrocortisone; ^eElectrolytes improve following permanent restoration of stress dose hydrocortisone.