Sustained remission of metastatic adrenal carcinoma during long-term administration of low-dose mitotane

We present our experience with two female patients suffering from metastati c, recurrent adrenocortical carcinomas, to whom o,p'-DDD (mitotane) was adm inistered for unusually long duration. The first patient received mitotane as monotherapy after relapse (in doses ranging from 3 to 6 g/day initially and 1 g/day thereafter, for 13 yr). The second patient presented with metas tatic disease and underwent radical surgical excision of the adrenal. Mitot ane was administered initially at 2.5 g/day, and the dose was gradually low ered over 8 yr to 1 g/day, without interruption. Both patients tolerated th e medication well, regardless of the daily dosage, with complaints limited to epigastric pain and nausea, while their disease has been kept under cont rol for 14 and 16 yr, respectively. The blockade of steroid synthesis with mitotane resulted in hypercholesterolemia in both patients and in premature menopause in the second patient; however, these abnormalities were taken c are of with the appropriate therapy. The excellent follow-up of these patie nts suggests that even in hopeless cases with metastatic adrenocortical car cinoma, mitotane should be administered for very long periods of time as it can be well-tolerated and may be beneficial in the long run. (J. Endocrino l. Invest. 24: 532-535, 2001) (C) 2001, Editrice Kurtis.