Which patient should not be administered mitotane?

Mitotane is a medication used primarily in the treatment of certain types of adrenal tumors, especially adrenocortical carcinoma. It functions by suppressing adrenal hormone production, which can be critical in managing hormone-secreting tumors.

Administering mitotane to a patient experiencing shock is contraindicated because this condition often requires stable hemodynamics and optimal adrenal function to manage stress responses effectively. When in shock, the body may be under significant physiological stress, and the adrenal glands typically respond by increasing the production of glucocorticoids. Introducing mitotane during this critical time can impair this natural response, potentially worsening the patient's condition by inhibiting necessary adrenal function that aids in maintaining cardiovascular stability and managing the body's response to stress.

On the other hand, chronic headaches, mild infections, or routine surgeries do not present the same immediate risk factors as shock does. In these situations, while monitoring and caution are always warranted, the use of mitotane may not be as critical or contraindicated. However, the complexities of each patient's overall health should always be considered.