text: Rethinking the management of immune checkpoint inhibitor related adrenal insufficiency in cancer patients during the COVID 19 pandemic The coronavirus disease 2019 COVID 19 is currently a major pandemic challenge and cancer patients are at a heightened risk of severity and mortality from this infection In recent years immune checkpoint inhibitor ICI use to treat multiple cancers has increased in oncology but equally has raised the question of whether ICI therapy and its side effects is harmful or beneficial during this pandemic A combination of published literature in PubMed between January 2010 and December 2020 recommended guidelines in non cancer patients and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI treated patients presenting with AI during this COVID 19 pandemic The potential immune interaction between ICIs and COVID 19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility severity and complications from the SARS CoV 2 sepsis Furthermore ICI use can induce autoimmune adrenal insufficiency AI that further increases infection susceptibility Thus ICI treated cancer patients with AI may be at greater risk of COVID 19 infection Glucocorticoids are the cornerstone for replacement therapy and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI related hypophysitis High dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis Furthermore in patients who develop the long COVID 19 syndrome when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia During the COVID 19 pandemic much of cancer care have been impacted and an important clinical question is how to optimally manage ICI related AI during these unprecedented times Herein we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI treated cancer patients presenting with AI during this COVID 19 pandemic 