Treating Adrenal Cancer

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Abstract
An early diagnosis of functioning adrenocortical carcinoma depends ou die physiuan's ability to recognize the clinical manifestations of excessive steroid hormone production by the tumor. Definition of the biochemical abnormality can be obtained with specific measurements of cortisol, aldosterone, and androgen or estrogen levels. Computerized tomography or magnetic resonance imaging can help localize the tumor and define die presence or absence of local and distant metastases. For non-functioning tumors, detection is frequently incidental to the investigation of nonspecific abdominal complaints. [131I]6-[beta]-iodomethyl-19-norcholesterol will image most benign tumors but is rarely taken up by malignant tumors. Surgical resection of the primary tumor or its recurrence and visible hepatic and pulmonary metastases increases life expectancy. Other methods of treatment, including radiation therapy and chemotherapy, are less effective. Mitotane extends survival for patients with adrenal carcinoma, particularly when it is administered early as adjuvant therapy or combined with repeated debulking resections of recurrent tumor. The toxicity associated with mitotane administration limits the use of larger and probably more effective doses. The synthesis of analogs of mitotane with reduced toxicity may provide better tools for the management of this cancer. (C) Lippincott-Raven Publishers.

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