title: Pregnancy in a patient with adrenal carcinoma treated with mitotane: a case report and review of literature.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) affects patients in a broad age group, including young women. Mitotane, an adrenolytic agent, is the mainstay of treatment after surgical removal of the tumor. There is extreme paucity of information regarding the effect of mitotane on childbearing potential and pregnancy outcome.
  
  
  OBJECTIVE
  The aim of the study was to describe and discuss the case of an ACC patient who conceived while on mitotane treatment. Current literature is reviewed.
  
  
  METHODS
  A 33-year-old woman received mitotane treatment for 4 years due to metastatic ACC. Despite nearly therapeutic blood levels of the drug, the patient had regular menstruation and was able to conceive. Mitotane was stopped at gestation week 6. Although the drug continued to be detected in considerable amounts, the fetus developed normally, including morphologically intact adrenal glands. At gestation week 21, pregnancy was terminated due to ACC recurrence. Mitotane levels were undetectable in fetal cord blood and amniotic fluid.
  
  
  CONCLUSIONS
  Our report suggests that mitotane, despite its action as an endocrine disruptor, does not affect normal gonadal function or an ability to conceive. The concern of placental transfer by this hydrophobic compound is not supported by our findings. However, we do not recommend drawing conclusions regarding the safety of mitotane in pregnancy, based on 1 or several case reports. Until more data are available, pregnancy should be avoided in women being treated with mitotane for ACC.
authors.affiliation: Diabetes and Endocrinology Unit, Hillel Yaffe Medical Center, POB 169, Hadera 38100, Israel. lianatrish@gmail.com
authors.forename: Liana
authors.initials: L
authors.lastname: Tripto-Shkolnik
authors.forename: Zeev
authors.initials: Z
authors.lastname: Blumenfeld
authors.forename: Moshe
authors.initials: M
authors.lastname: Bronshtein
authors.forename: Asher
authors.initials: A
authors.lastname: Salmon
authors.forename: Anat
authors.initials: A
authors.lastname: Jaffe
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008939:Mitotane / Q000627:therapeutic use*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D008939:Mitotane