34
Treatment
Table 4. Endocrine Toxicities
G2: Moderate symptoms, able
to perform ADL
• Consider holding ICPi until patient is stabilized on
replacement hormones.
• Endocrine consultation.
• Clinic evaluation to assess need for steroids and
volume repletion.
• Consider oral pulse dose therapy in patients with
MRI findings of swelling or threatened optic
chiasm compression (prednisone 1 mg/kg/day (or
equivalent). Taper over 1–2 weeks and transition to
physiologic maintenance therapy once down to 5
mg prednisone equivalent.
• Hormonal supplementation as in G1.
G3–4: Severe symptoms,
medically significant or life-
threatening consequences,
unable to perform ADL
• Hold ICPi until patient is stabilized on replacement
hormones.
• Endocrine consultation.
• Hospitalize or make an emergency department
(ED) referral for:
▶ Normal saline (at least 2L) or monitored free
water replacement if DI.
▶ IV Stress dose steroids: Hydrocortisone 50–100
mg Q6–8 hours initial dosing.
▶ Oral pulse dose therapy with Prednisone 1–2
mg/kg daily (or equivalent) tapered over at
least 1–2 weeks to physiologic maintenance in
patients with significant swelling on MRI, optic
chiasm compression, severe headache or visual
changes.
• Taper stress dose corticosteroids down to oral
maintenance doses over 5–7 days.
• Maintenance therapy as in G1.
(cont'd)
