Long-term (15 years) outcome in an infant with metastatic adrenocortical carcinoma

J Clin Endocrinol Metab. 2002 Oct;87(10):4452-6. doi: 10.1210/jc.2001-011978.

Abstract

Adrenocortical carcinoma is a rare malignancy in children, with a high mortality. Little is known about long-term outcome, especially in infants treated with mitotane. We report the successful long-term outcome of a case of metastatic adrenocortical carcinoma presenting in infancy treated with surgical resection and mitotane. The patient presented at 2 months of age with Cushing's syndrome, a large adrenal mass, and elevated adrenal steroid levels. The tumor was removed surgically. Intraoperative findings included an adrenal tumor (confirmed malignant pathologically) invading the adrenal vein and vena cava. After surgery he was treated with mitotane at a dose of 2 g/d. Six months after surgery 11-deoxycortisol levels increased, and a computed tomography scan showed a pulmonary metastasis. Mitotane was increased to 2.5 g/d, and the metastasis was removed surgically. Plasma mitotane levels ranged 10-15 micro g/ml. Tumor markers remained normal, and mitotane was discontinued at 18 months. During therapy the patient's somatic growth was poor. His motor and speech development was delayed. After mitotane was discontinued he demonstrated catch-up growth. This case shows successful long-term outcome and recovery from the toxic effects of mitotane.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenal Cortex Neoplasms / drug therapy
  • Adrenal Cortex Neoplasms / surgery*
  • Antineoplastic Agents, Hormonal / adverse effects
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Carcinoma / drug therapy
  • Carcinoma / surgery*
  • Cortodoxone / blood
  • Growth Disorders / chemically induced
  • Humans
  • Infant
  • Lung Neoplasms / secondary
  • Male
  • Mitotane / adverse effects
  • Mitotane / therapeutic use*
  • Neoplasm Metastasis*
  • Tomography, X-Ray Computed
  • Treatment Outcome*
  • Ultrasonography

Substances

  • Antineoplastic Agents, Hormonal
  • Mitotane
  • Cortodoxone