Departamento de Clínica Médica Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo São PauloSP Brasil Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil.
Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo São PauloSP Brasil Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil.
Arch Endocrinol Metab. 2024 Jul 1;68:e230441. doi: 10.20945/2359-4292-2023-0441. eCollection 2024.
Aldosterone-secreting adrenocortical carcinomas (ACCs) are rare and usually present as large tumors. The only potentially curative treatment for ACC is surgical resection. However, surgery may be unfeasible in some patients who have multiple comorbidities or decline the procedure. We describe herein the case of a 44-year-old man with aldosterone-secreting ACC who declined surgery because of religious convictions. As a Jehovah's Witness, the patient was concerned about requiring blood transfusion during surgery. Treatment with mitotane was started but interrupted due to hepatotoxicity. Subsequently, the patient was successfully treated with stereotactic ablative radiotherapy (SABR). After SABR, the patient had progressive improvement of pain, reduction in antihypertensive drugs, control of blood pressure and hypokalemia, normalization of serum aldosterone and renin levels, and reduction in tumor size and weight. To our knowledge, this is the first report of a patient with a pure aldosterone-secreting ACC who received SABR. The patient's response was substantial, showing that SABR could be considered as an alternative local treatment for aldosterone-secreting ACCs when surgery is unfeasible.
醛固酮分泌性肾上腺皮质癌（ACC）较为罕见，通常表现为大肿瘤。治疗 ACC 的唯一潜在治愈方法是手术切除。然而，对于有多种合并症或拒绝手术的患者，手术可能不可行。我们在此描述了一位 44 岁男性醛固酮分泌性 ACC 患者，由于宗教信仰而拒绝手术。作为一名耶和华见证人，该患者担心手术过程中需要输血。开始使用米托坦治疗，但因肝毒性而中断。随后，患者成功接受了立体定向消融放疗（SABR）治疗。SABR 治疗后，患者的疼痛逐渐缓解，降压药物减少，血压和低钾血症得到控制，血清醛固酮和肾素水平恢复正常，肿瘤体积和重量缩小。据我们所知，这是首例接受 SABR 治疗的纯醛固酮分泌性 ACC 患者的报告。患者的反应非常显著，表明当手术不可行时，SABR 可被视为治疗醛固酮分泌性 ACC 的替代局部治疗方法。
