Hypertriglyceridemia and its impact on mitotane monitoring in adrenocortical carcinoma.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Sandra Martens, Bruno Lapauw
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引用次数: 0

Abstract

Summary: Mitotane is used for treatment of advanced adrenocortical carcinoma. It is administered when the carcinoma is unresectable, metastasized, or at high-risk of recurrence after resection. In addition, mitotane is considered to have direct adrenolytic effects. Because of its narrow therapeutic-toxic range, therapeutic drug monitoring (TDM) is warranted. In 2020, a left-sided adrenal gland tumor was found (5.8 cm) in a 38-year-old man. Considering the size of this lesion and inability to exclude an adrenocortical carcinoma on imaging, a laparoscopic adrenalectomy was performed. Histopathologic examination determined presence of an adrenocortical carcinoma (pT2N0M0 ENSAT stadium II; ki67 10-15%). There was no evidence for residual or metastatic disease but given the high risk of recurrence, adjuvant therapy with mitotane was initiated. During TDM, a sudden and spuriously high level of mitotane was observed but without signs or symptoms of toxicity. After exploration, it was found that this high concentration was completely due to uncontrolled hypertriglyceridemia. After correction thereof, mitotane levels were again in the therapeutic range. This observation underscores the importance of TDM sampling in a fasting state with concurrent control of prevalent or incident dyslipidemia.

Learning points: TDM of mitotane is advocated to achieve therapeutic levels while avoiding toxicity. For correct TDM, sampling should be done at least 12 h after last intake of mitotane. Although sampling in fasting conditions in not explicitly mentioned in the guidelines, fasting state should be considered as elevated serum triglyceride levels might cause spuriously high mitotane levels. In patients undergoing treatment with mitotane and presenting with too high or unexplained fluctuating mitotane levels without signs or symptoms of toxicity, hypertriglyceridemia as a possible cause should be investigated. If dyslipidemia occurs in patients under mitotane treatment, other causes than mitotane (e.g. alcohol abuse and diabetes) should be considered and appropriate treatment should be initiated.

高甘油三酯血症及其对肾上腺皮质癌患者米托坦监测的影响。
摘要:米托坦用于晚期肾上腺皮质癌的治疗。当肿瘤无法切除、转移或切除后有复发的高风险时使用。此外,米托坦被认为有直接的肾上腺溶解作用。由于其狭窄的治疗毒性范围,治疗药物监测(TDM)是必要的。2020年,一名38岁男性发现左侧肾上腺肿瘤(5.8 cm)。考虑到该病变的大小和影像学上无法排除肾上腺皮质癌,我们进行了腹腔镜肾上腺切除术。组织病理学检查确定存在肾上腺皮质癌(pT2N0M0;ki67 10 - 15%)。没有残留或转移性疾病的证据,但考虑到复发的高风险,开始使用米托坦辅助治疗。在TDM期间,观察到突然和假高水平的米托坦,但没有毒性的体征或症状。经探索发现,这种高浓度完全是由于高甘油三酯血症失控所致。修正后,米托坦水平再次在治疗范围内。这一观察结果强调了在空腹状态下进行TDM采样的重要性,同时控制流行或偶发的血脂异常。学习要点:提倡米托坦的TDM达到治疗水平,同时避免毒性。对于正确的TDM,采样应在最后一次摄入米托坦后至少12小时进行。虽然指南中没有明确提到空腹条件下的采样,但空腹状态应考虑血清甘油三酯水平升高可能导致米托坦水平过高。在接受米托坦治疗的患者中,出现米托坦水平过高或不明原因的波动,且无毒性体征或症状,应调查高甘油三酯血症是否可能是原因。如果接受米托坦治疗的患者出现血脂异常,应考虑米托坦以外的其他原因(如酒精滥用和糖尿病),并应开始适当的治疗。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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