ECE2006 Poster Presentations Endocrine tumours and neoplasia (116 abstracts)
High performance liquid chromatography (HPLC) in the follow-up of mitotane therapy in a patient with adrenal carcinoma
D Thomas 1 , I Kostoglou-Athanassiou 1 , S Bournazos 1 , N Mytakidis 1 , V Liakos 1 , E Vassiliou 1 , P Athanassiou 2 & Ph Kaldrymidis 1
1Metaxa Hospital, Pireaus, Greece; 2Asclepeion Hospital, Athens, Greece.
Adrenal carcinoma is a rare neoplasm with poor prognosis. Mitotane (o,p′-DDD) is the only known therapeutic agent with action on the adrenal. Although it has been used for many decades, its pharmacological properties and exact mechanism of action are still debated. It has been suggested that its therapeutic effect is dose-dependent (Baudin et al 2001). High performance liquid chromatography (HPLC) has been used for the exact measurement of mitotane dose.
The aim of the study is to describe the case of a patient with adrenal carcinoma in which HPLC was used for the follow-up of mitotane blood therapeutic levels.
A female patient, aged 36 years, presented with a large nodule in the left adrenal and a cold thyroid nodule. The adrenal nodule was not hormone producing and was removed surgically. The size of the nodule was 10.3×5×19 cm and on histology it was proved to be an adrenal cortex carcinoma. A near total thyroidectomy was also performed and on histology a benign thyroid adenoma was found. On follow up 6 years after removal of the adrenal carcinoma the patient presented with metastatic disease in the liver and the lungs. An effort was made to surgically remove the metastases and mitotane was administered. Mitotane blood levels were monitored by HPLC. When the patient was on 2.5 g mitotane daily the respective blood levels of the drug were 4.629 μg/ml. The dose was increased to 3.5 g daily and the blood levels of the drug increased to 12.157 μg/ml.
Mitotane administration is necessary for the management of adrenal carcinoma. The use of HPLC contributes to therapy monitoring and the administration of the proper therapeutic dose while minimizing the danger of side effects.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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