Changes in total and acylated ghrelin levels during mitotane treatment in patients with adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a highly aggressive cancer with poor prognosis. Mitotane is the only approved drug for ACC treatment. Tolerability and efficacy of mitotane is variable. There is evidence that ghrelin may affect cancer development and the occurrence of side effects. We examined the differences in plasma ghrelin concentrations between patients with benign adrenal tumors and adrenal carcinoma. We also investigated the effect of mitotane treatment on circulating plasma ghrelin levels in patients with ACC. Additionally, we assessed the relationship between ghrelin concentrations, mitotane levels, and side effects of mitotane treatment. We enrolled 26 patients with ACC and 42 controls with adrenocortical adenoma (ACA). Clinical and histopathologic features, hormonal secretion pattern, and plasma acylated and total ghrelin levels were measured in every patient. Serum mitotane levels, body mass index, and side effects of mitotane treatment were estimated every 3 to 12 weeks during follow‑up in patients with ACC. There was no significant difference in total and acylated ghrelin concentrations between ACC and ACA groups before mitotane introduction in ACC. We observed that during mitotane treatment, both total and acylated ghrelin levels became elevated in ACC compared with ACA. A positive correlation was found between circulating mitotane levels and acylated ghrelin as well as the ratio of acylated to total ghrelin levels in all patients treated with mitotane. Higher ghrelin levels were associated with increased risk of side effects. Plasma ghrelin levels are changed during mitotane treatment. These changes may be connected with side effects of mitotane.