Metastatic Adrenal Cortical Carcinoma

CURRENTLY, there is a disagreement concerning the effectiveness of mitotane (o,p'-DDD) (1,1-dichloro-2-[o-chlorophenyl]-2-[p-chlorophenyl]-ethane) in the therapy for metastatic adrenal cortical carcinoma. Following the initial favorable report,¹measurable tumor response was observed in two large series in 34 %²and 61 %³of patients treated with this drug, and overall survival was prolonged when compared with an earlier group of untreated persons whose mean survival was 2.9 months. However, in another series,⁴survival was not improved. The following case is presented to illustrate a long-term remission of adrenocortical carcinoma and the effects that have been associated with the ingestion of more than 13 kg of mitotane. Report of a Case A 49-year-old woman was admitted to a hospital in November 1967 with hirsutism and masses in the left breast and abdomen. Roentgenograms disclosed metastases in the ribs and liver and downward displacement of the left kidney. Two 24-hour urine collections