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The impact of mitotane therapy on serum-free proteins in patients with adrenocortical carcinoma
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Lech, Magdalena, Ranasinghe, Ruvini, Vincent, Royce P., Taylor, David R., Ghataore, Lea, Luxton, James, Lajeunesse-Trempe, Fannie, Roser, Pia, Drakou, Eftychia E., Chuah, Ling Ling, Grossman, Ashley B., Aylwin, Simon J. B. and Dimitriadis, Georgios K. (2024) The impact of mitotane therapy on serum-free proteins in patients with adrenocortical carcinoma. Endocrine connections, 13 (3). e230159. doi:10.1530/EC-23-0159 ISSN 2049-3614.
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Official URL: http://doi.org/10.1530/EC-23-0159
Abstract
Introduction
Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal cortex. Whilst surgery is the preferred treatment, adjunctive therapy with mitotane may be offered post-surgically to minimise the risk of recurrence or, in the absence of surgery, to attenuate progression.
Aim
The objective was to evaluate the effects of mitotane treatment on serum protein concentrations in patients treated for ACC with mitotane therapy and compare this to patients with other adrenal neoplasms and a normal pregnant cohort.
Methods
Serum cortisol, thyroid function tests, adrenocorticotrophic hormone (ACTH), cortisol-binding globulin (CBG), thyroxine-binding globulin (TBG), gonadotrophins and androgens were measured on plasma and serum samples. Thirty-five patients with ACC were included, and mitotane levels were noted to be sub-/supra-therapeutic. Data were tested for normality, reported as mean ± s.d., and compared to other two cohorts using paired-sample t-test with a 5% P-value for significance and a 95% CI.
Results
Patients on mitotane therapy had a higher mean serum CBG concentration compared to the adrenal neoplasm group (sub-therapeutic: 79.5 (95% CI: 33.6, 125.4 nmol/L), therapeutic: 85.3 (95% CI: 37.1–133.6 nmol/L), supra-therapeutic: 75.7 (95% CI: −19.3, 170.6 nmol/L) and adrenal neoplasm: 25.5 (95% CI: 17.5, 33.5 nmol/L). Negative correlations between serum cortisol and CBG concentration were demonstrated within the supra-therapeutic plasma mitotane and adrenal neoplasm groups.
Conclusion
Patients with ACC and therapeutic plasma mitotane concentrations had higher serum CBG concentrations compared to those with adrenal neoplasms or pregnant women, and higher serum cortisol. Whilst there was no direct correlation with cortisol and mitotane level, the negative correlation of cortisol with CBG may suggest that the direct effect of mitotane in increasing cortisol may also reflect that mitotane has a direct adrenolytic effect.
Item Type: | Journal Article | ||||
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Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
Library of Congress Subject Headings (LCSH): | Adrenal glands -- Cancer, Adrenal glands -- Cancer -- Treatment, Blood proteins, Globulins | ||||
Journal or Publication Title: | Endocrine connections | ||||
Publisher: | BioScientifica Ltd. | ||||
ISSN: | 2049-3614 | ||||
Official Date: | 12 February 2024 | ||||
Dates: |
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Volume: | 13 | ||||
Number: | 3 | ||||
Article Number: | e230159 | ||||
DOI: | 10.1530/EC-23-0159 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Date of first compliant deposit: | 7 March 2024 | ||||
Date of first compliant Open Access: | 7 March 2024 |
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