Medical Adrenalectomy with Aminoglutethimide

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Abstract
The use of adrenalectomy and hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma is reserved for highly selected patients. As an alternate approach, a pharmacologic method of inhibiting adrenal cortical secretion was developed which consisted of the daily administration of 1000 mg of aminoglutethimide to block steroidogenesis and dexamethasone (2.0-3.0 mg/day) or hydrocortisone (40-60 mg/day) as replacement glucocorticoid. This regimen markedly suppressed plasma levels of DHA-S [dehydroepiandrosterone sulfate] androstenedione, estrone and estradiol and urinary levels of aldosterone. Of 50 patients treated, 19 (38%) demonstrated a complete (8/19) or partial (11/19) objective disease remission which lasted for 18.05 .+-. 3.1 mo. (mean .+-. SEM). In 10 (20%) patients, there was stabilization of disease (7.8 .+-. 1.2 mo.), accompanied by symptomatic relief of bone pain in 6 (12%). There was disease progression in 20 (40%) patients. The acute side effects of aminoglutethimide therapy were significant and consisted of transient lethargy (41.5%) and a cutaneous rash (35.8%). Chronic toxicity was negligible. The medical adrenalectomy regimen of aminoglutethimide plus glucocorticoid offers a suitable alternative to surgical adrenalectomy or hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma.