adrenal insufficiency and chemo

Patient has lung cancer, cancer removed surgically, chemo begins as preventative.  The patient has one round of chemo and 5 days later passes out, is hyponatremic and dehydrated.  the next day the blood work shows WBC of 7.7 and absolute neutro is 7.0 however the RBC, HGB, HCT and absolute mono are all low.  There is a suspect of the possibility of low cortisol and it is being tested.  Results are not yet back on the low cortisol.  Would it make sense to have chemo the very next day with the possibility of adrenal insuffficiency?  Can you recover from hyponatremia and dehydration in less than 24 hours? Wouldn't chemo and low cortisol put the patient in a very compromising position?  Does chemo affect the adrenal insufficiency issue.  THanks

[riley180]

Hi.
The description of the case makes me consider a few things: one is that the surgery proceeded uneventfully. If the patient had a limited reserve, then I think that the post-operative period would have been stormy. Under this scenario, I think that the patient does not have a problem with adrenal crises.
The second assumption, is that the preventive chemotherapy is likely one which employs a platinum agent, which I’m guessing would be cisplatin.
Could it be induced by the chemotherapy?
There may be an effect of the chemotherapy on the kidney – in which certain electrolytes may be lost. For cisplatin, the usual scenario is low potassium and magnesium, not low sodium. The usual description of adrenal insufficiency would be low sodium and high potassium.
Treatment with steroids while receiving chemotherapy is usually done as prophylaxis for nausea and vomiting. Nausea and vomiting is usually worse during the first 3 or 4 days. It is possible that the steroids achieved suppression of the patient’s normal steroid production, and then when the steroids were discontinued- the body is unable to catch up and you get adrenal insufficiency. If this is the case, it is possible to slowly wean the patient off the steroid so as to avoid the complication.
Could it be the cancer itself?
Lung cancer has a predisposition to hit the adrenal glands. I am assuming that prior to surgery – this was evaluated and was found negative.
Lung cancer is also associated with a syndrome of inappropriate antidiuretic hormone, in which the body retains fluid and this account for low sodium. The scenario though is unlikely in a completely resected case.
On recovery:
Correcting hyponatremia can be done in a day if the deficit is not too severe.

In general, I think it would be important to find out what the problem was so as to better plan the subsequent chemotherapy.