The impact of mitotane therapy on serum free proteins in patients with adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal cortex. Whilst surgery is the preferred treatment, adjunctive therapy with mitotane may be offered post-surgically to minimise the risk of recurrence or in the absence of surgery to attenuate progression. To evaluate the effects of m...

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Veröffentlicht in:Endocrine Connections 2024-03, Vol.13 (3), p.1-10
Hauptverfasser: Lech, Magdalena, Ranasinghe, Ruvini, Vincent, Royce P, Taylor, David R, Ghataore, Lea, Luxton, James, Lajeunesse-Trempe, Fannie, Roser, Pia, Drakou, Eftychia E, Chuah, Ling Ling, Grossman, Ashley B, Aylwin, Simon Jb, Dimitriadis, Georgios K
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Sprache:eng
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Zusammenfassung:Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal cortex. Whilst surgery is the preferred treatment, adjunctive therapy with mitotane may be offered post-surgically to minimise the risk of recurrence or in the absence of surgery to attenuate progression. To evaluate the effects of mitotane treatment on serum protein concentrations in patients treated for ACC with mitotane therapy and compare this to patients with other adrenal neoplasms and a normal pregnant cohort. Serum cortisol, thyroid function tests, adrenocorticotrophic hormone (ACTH), cortisol-binding globulin (CBG), thyroxine-binding globulin (TBG), gonadotrophins and androgens were measured on plasma and serum samples. Thirty-five patients with ACC were included, and mitotane levels noted to be sub-/supra-/therapeutic. Data were tested for normality, reported as means ± SD, and compared to other two cohorts using paired-sample t-test with 5% p-value for significance and 95% confidence interval (CI). Patients on mitotane therapy had higher mean serum CBG concentration compared to the adrenal neoplasm group (sub-therapeutic: 79.5 (95% CI:33.6, 125.4nmol/L), therapeutic: 85.3 (95% CI:37.1-133.6nmol/L), supra-therapeutic: 75.7 (95% CI: -19.3,170.6nmol/L): adrenal neoplasm 25.5 (95% CI:17.5,33.5nmol/L). Negative correlations between serum cortisol and CBG concentration were demonstrated within the supra-/therapeutic plasma mitotane and adrenal neoplasm groups. Patients with ACC and therapeutic plasma mitotane concentrations had higher serum CBG concentrations compared to those with adrenal neoplasms or pregnant women, and higher serum cortisol. While there was no direct correlation with cortisol and mitotane level, the negative correlation of cortisol with CBG may suggest that the direct effect of mitotane in increasing cortisol may also reflect that mitotane has a direct adrenolytic effect.
ISSN:2049-3614
2049-3614
DOI:10.1530/EC-23-0159