Szkodziak Piotr, Szkodziak Filip, Korolczuk Agnieszka, Obel Ewa, Woźniak Sławomir, Paszkowski Tomasz
3rd Chair and Department of Gynaecology, Medical University of Lublin Lublin, Poland.
Chair and Department of Clinical Pathomorphology, Medical University of Lublin Lublin, Poland.
Am J Cancer Res. 2024 Apr 15;14(4):1802-1814. doi: 10.62347/QKWF9884. eCollection 2024.
Adrenocortical carcinoma (ACC) is a malignant tumour that originates from the adrenal cortex. It is a highly aggressive cancer characterised by a poor prognosis with an annual incidence estimated to be up to 2 cases per million. In the adult population, ACC is diagnosed typically between 40 and 50 years of age, more often in women. Complete surgical resection of the tumour is the primary treatment method for ACC. Unfortunately, despite properly performed adrenalectomy, regional recurrences or distant metastases are detected in up to 90% of the patients. For that reason, adjuvant therapy is recommended. Mitotane is the most effective adrenal-specific agent used in adjuvant and palliative therapy. Two menstruating patients, after adrenalectomy due to ACC, during adjuvant mitotane therapy, have been included in the study. The study aimed to assess the effect of mitotane therapy on the endometrium and its clinical consequences, based on the analysis of these two cases and a review of the literature. It seems that menorrhagia may be expected during adjuvant mitotane therapy of ACC in menstruating women. Heavy uterine bleeding during menstruation may appear several months after the beginning of therapy. The likely mechanism for heavy menstrual bleeding is complex. Menorrhagia can occur due to the toxic effect of mitotane in the form of a haemorrhagic diathesis, while long-term treatment (over ten months) can lead to relative hypoestrogenism resulting in endometrial hyperplasia. Clinical signs of hypoestrogenism during mitotane treatment, have been described (including pre-puberty girls) and should be considered as a side-effect of the therapy. Menorrhagia may lead to severe anaemia, so this should be considered when planning mitotane treatment. Continuous gestagen therapy is helpful in the treatment of the above disorders. After over 60 years of experience with mitotane usage, knowledge about it is still insufficient, and further studies are required.
肾上腺皮质癌（ACC）是一种起源于肾上腺皮质的恶性肿瘤。它是一种侵袭性很强的癌症，预后较差，估计年发病率高达百万分之二。在成年人群中，ACC通常在40至50岁之间被诊断出来，女性更为常见。肿瘤的完整手术切除是ACC的主要治疗方法。不幸的是，尽管肾上腺切除术操作得当，但仍有高达90%的患者出现局部复发或远处转移。因此，建议进行辅助治疗。米托坦是辅助治疗和姑息治疗中最有效的肾上腺特异性药物。本研究纳入了两名因ACC接受肾上腺切除术后在辅助米托坦治疗期间的月经女性患者。该研究旨在通过对这两个病例的分析以及文献回顾，评估米托坦治疗对子宫内膜的影响及其临床后果。似乎在月经女性的ACC辅助米托坦治疗期间可能会出现月经过多。月经期间大量子宫出血可能在治疗开始几个月后出现。月经过多的可能机制很复杂。月经过多可能是由于米托坦以出血素质形式产生的毒性作用，而长期治疗（超过十个月）可能导致相对雌激素缺乏，从而导致子宫内膜增生。米托坦治疗期间雌激素缺乏的临床症状已有描述（包括青春期前女孩），应被视为该治疗的副作用。月经过多可能导致严重贫血，因此在计划米托坦治疗时应予以考虑。持续孕激素治疗有助于治疗上述疾病。在使用米托坦超过60年的经验之后，对其的了解仍然不足，还需要进一步研究。
