PDF(Pubmed)
Abstract：
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.
摘要：
肾上腺皮质癌（ACC）是一种起源于肾上腺皮质的恶性肿瘤。它是一种高度侵袭性的癌症，其特征是预后不良，年发病率估计高达每百万2例。在成年人口中，ACC的诊断通常在40至50岁之间，更多的是女性。完全手术切除肿瘤是ACC的主要治疗方法。不幸的是,尽管进行了适当的肾上腺切除术，在高达90%的患者中检测到局部复发或远处转移.出于这个原因,推荐辅助治疗。Mitotane是用于辅助和姑息治疗的最有效的肾上腺特异性药物。两个来月经的病人,由于ACC的肾上腺切除术后，在米托坦辅助治疗期间，已被纳入研究。该研究旨在评估米托坦治疗对子宫内膜的影响及其临床后果，在对这两个案例进行分析和文献综述的基础上。似乎在月经来潮妇女的ACC辅助米托坦治疗期间可能会出现月经过多。月经期间的大量子宫出血可能在治疗开始后几个月出现。大量月经出血的可能机制很复杂。由于米托坦的毒性作用，以出血性素质的形式出现月经过多，而长期治疗（超过10个月）可导致相对低雌激素，导致子宫内膜增生。米托坦治疗期间雌激素不足的临床体征，已被描述（包括青春期前的女孩），应被视为治疗的副作用。月经过多可能导致严重贫血，所以在计划米托坦治疗时应该考虑这一点。连续孕激素治疗有助于上述疾病的治疗。在使用米托坦超过60年的经验之后，对它的了解仍然不足，需要进一步研究。
