Mitotane treatment in patients with metastatic testicular Leydig cell tumor associated with severe androgen excess.

Autor:	Chortis V; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK., Johal NJ; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK., Bancos I; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.; Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA., Evans M; Departments of Pathology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Skordilis K; Departments of Pathology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Guest P; Radiology and Cancer Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Cullen MH; Cancer Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Porfiri E; Cancer Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Arlt W; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
Jazyk:	angličtina
Zdroj:	European journal of endocrinology [Eur J Endocrinol] 2018 Mar; Vol. 178 (3), pp. K21-K27. Date of Electronic Publication: 2018 Jan 12.
DOI:	10.1530/EJE-17-0542
Abstrakt:	Mitotane (o,p'DDD) is established in the adjuvant and advanced-stage treatment of adrenocortical carcinoma and counteracts both tumor growth and tumor-related steroid production. Both the adrenal glands and the gonads are steroidogenically active organs and share a common embryogenic origin. Here, we describe the effects of mitotane in two patients with metastatic Leydig cell tumor (LCT) of the testes and associated severe androgen excess (serum testosterone 93 and 88 nmol/L, respectively; male reference range 7-27 nmol/L). Both men suffered from severe restlessness, insomnia and irritability, which they described as intolerable and disrupting normal life activities. Urinary steroid profiling by gas chromatography-mass spectrometry (GC-MS) confirmed excess androgen production and revealed concurrent overproduction of glucocorticoids and glucocorticoid precursors, which under physiological conditions are produced only by the adrenal glands but not by the gonads. In a palliative approach, they were commenced on mitotane, which achieved swift control of the hormone excess and the debilitating clinical symptoms, restoring normal quality of life. GC-MS demonstrated normalization of steroid production and decreased 5α-reductase activity, resulting in decreased androgen activation, and imaging demonstrated disease stabilization for 4-10 months. In conclusion, mitotane can be highly effective in controlling steroid excess in metastatic LCTs, with anti-tumor activity in some cases. (© 2017 The authors.)
Databáze:	MEDLINE
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