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Adrenal Emergencies in Critically Ill Cancer Patients

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Abstract

The presentation of an adrenal emergency to critical care providers may range from manifestations resulting from the underproduction of cortisol leading to shock in cases of adrenal crisis, to poorly controlled hypertension through over production of catecholamines in cases of pheochromocytoma. The diversity of presentations underscores the critical role of the adrenal glands in maintaining homeostasis. While pheochromocytoma represents a rare primary malignancy, adrenal insufficiency is more typically the result of treatment of complications related to other primary malignancies. In the case of adrenal insufficiency, the provider must replace hormone while at the same time work to distinguish between multiple etiologies. Importantly, the provider should recognize the mechanisms by which medications prescribed to treat malignancy may have side effects causing adrenal insufficiency. In pheochromocytoma, control of malignant hypertension is important while also determining the underlying cause. In both cases the prognosis is determined, like in most areas of medicine, by the etiology. In most cases, with supportive care, the prognosis is favorable.

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Authors and Affiliations

  1. University of Virginia, Charlottesville, VA, USA

    Ryan P. Richard & Julie A. Grishaw

  2. Division of Critical Care and Pulmonary Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA

    Kyle B. Enfield

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  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

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Richard, R.P., Grishaw, J.A., Enfield, K.B. (2020). Adrenal Emergencies in Critically Ill Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_81

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