A case of recurrent adrenocortical carcinoma, with observations on long-term o,p'-DDD therapy and complications.
This report describes a patient with a recurring, one stemline-aneuploid, adrenocortical carcinoma. The condition showed a number of unusual characteristics over a period of 22 yr. It changed from a biochemically functioning, low-grade malignant tumour into a non-functioning malignancy with pronounced mitotic activity, accompanied by an ovarian carcinosarcoma 1 yr before death. Quality of life was reasonable for many years despite chemotherapy, consisting of a total of almost 10 kg of o,p'-DDD administered over a period of 8 yr, and the subsequent side effects (e.g. low T4; increased bleeding time). A reduced mineralocorticoid activity, induced by o,p'-DDD, was reversed after discontinuation of o,p'-DDD treatment. During o,p'-DDD administration the substitution requirements for both hydrocortisone and fludrocortisone acetate increased, leading to periods of hypoadrenocorticism with prerenal uraemia.
van Aalderen
W
W
Diaconessenhuis, Leiden, Netherlands.
van Seters
A P
AP
Backer
E T
ET
Chang
P C
PC
van Krieken
J H
JH
Moolenaar
A J
AJ
D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D002296:Carcinosarcoma / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D016609:Neoplasms, Second Primary; D010051:Ovarian Neoplasms / Q000473:pathology; D013997:Time Factors
D008939:Mitotane