How should I approach the follow-up and monitoring of a patient after treatment for adrenal cancer?

Follow-up and monitoring of a patient after treatment for adrenal cancer should involve ongoing reviews with an appropriate specialist endocrine team to assess adrenal function and manage any adrenal insufficiency. This includes regular clinical assessments and adjustment of glucocorticoid and mineralocorticoid replacement therapy as needed, especially if adrenal insufficiency develops post-treatment.

Frequency of reviews should be tailored to the patient's clinical needs, with more frequent reviews around diagnosis, during periods of clinical change, and if there are concerns about medication adherence or self-management ability. For children and young people, at least 6-monthly appointments and annual face-to-face reviews are recommended to monitor growth and adjust treatment.

Monitoring should also include assessment for late effects of treatment, such as endocrine dysfunction, given that adrenal cancer treatment may involve surgery and possibly radiotherapy, which can affect pituitary and adrenal function. Regular endocrine function tests should be considered, especially if radiotherapy was part of treatment.

Imaging and clinical surveillance should be guided by specialist teams, considering the risk of recurrence or metastases, with a personalised approach to follow-up intervals and investigations.