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An Adrenocortical Carcinoma Patient with Multiple Lung Metastases — A Case Report
Adrenocortical carcinoma with lung metastases
Tzu Chi Med J 2005 17 No. 2 NMR
An Adrenocortical Carcinoma Patient with Multiple Lung
Metastases — A Case Report
Shuen-Fu Weng, Ching-Chung Chang, Deng-Huang Su
1
, Yih-Leong Chang
2
Department of Internal Medicine, Pathology2, National Taiwan University College of Medicine and National Taiwan University
Hospital, Taipei, Taiwan; Department of Internal Medicine, Far Eastern Polyclinic1, Taipei, Taiwan
ABSTRACT
Adrenocortical carcinoma is a rare cause of Cushing’s syndrome. Its aggressive behavior leads to a poor prognosis. Mitotane (o,p’-
DDD) is the mainstay of medical therapy, but the adverse effects often limit its use. We report on a patient with adrenocortical
carcinoma who was treated with mitotane. A 42-year-old woman presented with Cushing’s syndrome and hirsutism. There were
lung metastases at diagnosis. Right radical adrenalectomy and multiple lung metastatectomy were performed. Six months later,
mitotane was administered for widely-disseminated metastases. It was discontinued because of severe side effects including dizziness,
headache, generalized weakness, nausea, and vomiting. The patient died of hepatic failure one year after diagnosis. In these patients,
mitotane may be used immediately after surgical resection as an adjuvant therapy if residual tumors were considered. A low-dose
mitotane regimen should be given with monitoring of the serum level of the drug to obtain an optimal effect. Systemic chemo-
therapy may be administered or combined with mitotane if the tumor is poorly responsive to mitotane or the patient can not tolerate
the drug. More experience is needed to determine the effect of various treatments. (Tzu Chi Med J 2005; 17:105-109)
Key words: adrenocortical carcinoma, lung metastasis, mitotane, Cushing’s syndrome
Received: September 8, 2004, Revised: September 21, 2004, Accepted: October 7, 2004
Address reprint requests and correspondence to: Dr. Ching-Chung Chang, Department of Interna
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