- 期刊
An Adrenocortical Carcinoma Patient with Multiple Lung Metastases-A Case Report
腎上腺皮質癌合併肺部多處轉移－病例報告
摘要
腎上腺皮質癌是庫欣氏症候群的一種罕見原因，且它的侵略性導致預後不良。Mitotane (o,p’-DDD)是藥物治療的主流，但副作用常限制了它的使用。本文報告一個以mitotane治療腎上腺皮質癌的病例。一位四十二歲的女性以庫欣氏症候群及多毛症表現，在診斷腎上腺皮質癌時已有肺部轉移。病人接受右側根除性腎上腺切除術及肺部轉移腫瘤切除術。六個月後，病人因為疾病廣泛轉移而接受mitotane治療，但因為嚴重副作用而停藥，其副作用包括頭暈、頭痛、虛弱、噁心及噁吐。此病人在診斷一年後死於肝衰竭。對於這樣的病人，若懷疑有殘存腫瘤，也許應在手術切除後立即開始使用mitotane，以為輔助療法。爲了達到最佳效果，應該使用低劑量mitotane處方，且監測血清藥物濃度。若mitotane對腫瘤的治療效果不好，或病人無法忍受mitotane的副作用，可給予全身性化學治療，甚至合併mitotane使用。吾人仍需要更多經驗以確定各種治療方法的效果。
並列摘要
Adrenocortical carcinoma is a rare cause of Cushing's syndrome. Its aggressive behavior leads to a poor prognosis. Mitotane (o,p'-DDD) is the mainstay of medical therapy, but the adverse effects often limit its use. We report on a patient with adrenocortical carcinoma who was treated with mitotane. A 42-year-old woman presented with Cushing's syndrome and hirsutism. There were lung metastases at diagnosis. Right radical adrenalectomy and multiple lung metastatectomy were performed. Six months later, mitotane was administered for widely-disseminated metastases. It was discontinued because of severe side effects including dizziness, headache, generalized weakness, nausea, and vomiting. The patient died of hepatic failure one year after diagnosis. In these patients, mitotane may be used immediately after surgical resection as an adjuvant therapy if residual tumors were considered. A low-dose mitotane regimen should be given with monitoring of the serum level of the drug to obtain an optimal effect. Systemic chemotherapy may be administered or combined with mitotane if the tumor is poorly responsive to mitotane or the patient can not tolerate the drug. More experience is needed to determine the effect of various treatments.
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