title: Late recurrence of operated adrenocortical carcinoma: atrial natriuretic factor before and after treatment with mitotane.
abstract: A 62-year-old man arrived at our hospital with recurrence of Cushing's syndrome 14 years after successful surgery for adrenocortical carcinoma. Investigations demonstrated recurrence of a large tumor above the right adrenal area; it was found to be inoperable. The patient was treated initially with a new glucocorticoid antagonist, RU 486, and later with the adrenolytic agent mitotane (o,p'DDD). The latter achieved hypoadrenocorticism and a substantial reduction of tumor size. During the initial period, worsening hyperadrenocorticism resulted in a rise of atrial natriuretic factor and an inhibition of renin activity, consistent with an increase of cortisol and plasma volume. Changes in opposite direction were observed after treatment with mitotane.
authors.affiliation: Department of Internal Medicine, University of Louvain, Academic Hospital of Mont-Godinne, Yvoir, Belgium.
authors.forename: J E
authors.initials: JE
authors.lastname: Donckier
authors.forename: L A
authors.initials: LA
authors.lastname: Michel
authors.forename: A
authors.initials: A
authors.lastname: Berbinschi
authors.forename: P M
authors.initials: PM
authors.lastname: De Coster
authors.forename: J F
authors.initials: JF
authors.lastname: De Plaen
authors.forename: J M
authors.initials: JM
authors.lastname: Ketelslegers
authors.forename: M
authors.initials: M
authors.lastname: Buysschaert
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002277:Carcinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000097:blood / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy*; D012083:Renin / Q000097:blood; D013997:Time Factors
chemical_list: D008939:Mitotane; D009320:Atrial Natriuretic Factor; D012083:Renin