Metastatic Adrenal Cortical Carcinoma: Biochemical Changes Accompanying Clinical Regression During Therapy with o,p'-DDD

• Published in: Clinical chemistry (Baltimore, Md.) Vol. 17; no. 12; pp. 1191 - 1193
• Main Authors: Helson, Lawrence, Wollner, Norma, Murphy, M. Lois, Schwartz, Morton K
• Format: Journal Article
• Language: English
• Published: England Am Assoc Clin Chem 01.12.1971
• Subjects: 17-Hydroxycorticosteroids - urine; 17-Ketosteroids - urine; Abdominal Neoplasms - complications; Abdominal Neoplasms - drug therapy; Abdominal Neoplasms - urine; Acetates - therapeutic use; Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - drug therapy; Adrenal Gland Neoplasms - urine; Adrenal Insufficiency - complications; Adrenal Insufficiency - drug therapy; Adrenal Insufficiency - urine; Adrenalectomy; Adrenocorticotropic Hormone - pharmacology; Carcinoma - complications; Carcinoma - drug therapy; Carcinoma - urine; Child; Cortisone - therapeutic use; Dexamethasone - pharmacology; Dexamethasone - therapeutic use; Dichlorodiphenyldichloroethane - therapeutic use; Female; Fluorine - therapeutic use; Humans; Hydrocortisone - therapeutic use; Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Lung Neoplasms - urine; Metabolism - drug effects; Neoplasm Metastasis; Prednisolone - therapeutic use; Radiography; Splenectomy; Virilism - etiology
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1093/clinchem/17.12.1191

Abstract A 7-year-old girl with a six-month history of increasing virilism, growth, and acne excreted supranormal amounts of urinary 17-ketosteroids (87.6 mg/24 h). ACTH stimulation and dexamethasone suppression studies indicated adrenal tumor. A large left adrenal carcinoma was removed. Metastases were not observed. Postoperatively, 24-h urinary ketosteroids remained supranormal (16 mg). Sudden fever, cough, and hemoptysis precipitated hospitalization 42 months later. Bilateral lung metastases, a mass in the right upper quadrant, virilism, advanced bone age, and supranormal 24-h urinary ketosteroids (166 mg) and hydroxysteroids (16 mg) were found. The patient received 240 g of o,p'-dichlorodiphenyl-dichloroethane (o,p'-DDD), whereupon the abdominal mass and lung lesions regressed and 24-h urinary ketosteroids and hydroxysteroids decreased. Since this treatment (which ended April, 1968) the patient has been maintained at home on 7.5 g o,p'-DDD/day and replacement therapy with 9-α-fluorohydrocortisone and cortisone acetate. Almost all signs and symptoms have disappeared and urinary steroids are normal.