title: Hepatic microsomal enzyme induction and adrenal crisis due to o,p'DDD therapy for metastatic adrenocortical carcinoma.
abstract: Two cases are described in which metastatic adrenocortical carcinoma associated with Cushing's syndrome was treated with mitotane (o,p'DDD). The first patient had initially been treated by bilateral adrenalectomy and, whilst responding to mitotane biochemically and by remission of metastases, experienced repeated episodes of adrenal crisis requiring a substantial increase in steroid therapy. The second patient failed to respond to the drug, but evidence of hepatic enzyme induction was noted during its administration. It is suggested that hepatic microsomal enzyme induction can occur in association with treatment with mitotane and that this can lead to an increased destruction of exogenous steroid with clinical consequences.
authors.affiliation: Department of Medicine, District General Hospital, Barnsley, UK.
authors.forename: R V
authors.initials: RV
authors.lastname: Hague
authors.forename: W
authors.initials: W
authors.lastname: May
authors.forename: D R
authors.initials: DR
authors.lastname: Cullen
mesh_terms: D000224:Addison Disease / Q000139:chemically induced* / Q000188:drug therapy; D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy*; D000315:Adrenalectomy; D000328:Adult; D000410:Alanine Transaminase / Q000096:biosynthesis; D001219:Aspartate Aminotransferases / Q000096:biosynthesis; D002277:Carcinoma / Q000188:drug therapy* / Q000556:secondary; D003131:Combined Modality Therapy; D004790:Enzyme Induction / Q000187:drug effects; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008862:Microsomes, Liver / Q000187:drug effects* / Q000201:enzymology; D008875:Middle Aged; D008939:Mitotane / Q000009:adverse effects* / Q000627:therapeutic use; D005723:gamma-Glutamyltransferase / Q000096:biosynthesis
chemical_list: D008939:Mitotane; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D005438:Fludrocortisone; D006854:Hydrocortisone