title: Medical adrenalectomy with aminoglutethimide: clinical studies in postmenopausal patients with metastatic breast carcinoma.
abstract: The use of adrenalectomy and hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma is reserved for highly selected patients. As an alternate approach, a pharmacologic method of inhibiting adrenal cortical secretion was developed which consisted of the daily administration of 1000 mg of aminoglutethimide to block steroidogensis and either dexamethasone (2.0-3.0 mg/day) or hydrocortisone (40-60 mg/day) as replacement glucocorticoid. This regimen markedly suppressed plasma levels of DHA-S, androstenedione, estrone, and estradiol, and urinary levels of aldosterone. Of 50 patients treated, 19 (38%) demonstrated either a complete (8/19) or a partial (11/19) objective disease remission which lasted for 18.05 +/- 3.1 months (mean +/- SEM). In 10 (20%) patients, there was stabilization of disease (7.8 +/- 1.2 months), accompanied by symptomatic relief of bone pain in six (12%). There was disease progression in 20 (40%) patients. The acute side effects of aminoglutethimide therapy were significant and consisted of transient lethargy (41.5%) and a cutaneous rash (35.8%). Chronic toxicity was negligible. The medical adrenalectomy regimen of aminoglutethimide plus glucocorticoid offers a suitable alternative to surgical adrenalectomy or hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma.
mesh_terms: D000302:Adrenal Cortex / Q000187:drug effects*; D000315:Adrenalectomy / Q000379:methods*; D000450:Aldosterone / Q000652:urine; D000616:Aminoglutethimide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000735:Androstenedione / Q000097:blood; D001859:Bone Neoplasms / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000188:drug therapy*; D004341:Drug Evaluation; D004967:Estrogens / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007016:Hypophysectomy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008593:Menopause; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011388:Prolactin / Q000097:blood; D011859:Radiography; D012075:Remission, Spontaneous; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D013997:Time Factors
chemical_list: D004967:Estrogens; D000616:Aminoglutethimide; D000735:Androstenedione; D000450:Aldosterone; D011388:Prolactin; D013972:Thyrotropin; D013974:Thyroxine