Regression of an adrenal cortical carcinoma and its neovascular bed following mitotane therapy: A case report

A 48-year-old Caucasian woman who had increasing hirsutism over a 2-year period was finally hospitalized because of acute abdominal pain. Pulmonary metastases were present. An exploratory laparotomy revealed a large, highly vascular, inoperable adrenal neoplasm. Seventeen ketosteroids and 17 ketogenic steroids were significantly elevated. An abdominal aortogram with selective catheterization established the size and vascularity of the abdominal mass. Treatment with mitotane resulted in a remarkably prompt return to normal of the urinary ketosteroids and corticosteroids and regression of the pulmonary metastases. Repeat arteriographic studies showed a marked reduction in the abnormal vascularity as well as in the size of the abdominal mass. The patient has been maintained on mitotane for most of the 4 years since starting therapy. To date there has been no evidence of reactivation of any of the neoplastic foci.