Adding metyrapone to chemotherapy plus mitotane for Cushing’s syndrome due to advanced adrenocortical carcinoma
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Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine tumor that is actively secreting in approximately 50% of adult patients. Cushing’s syndrome is the most commonly associated endocrine disorder  that negatively influences the outcome of ACC patients, due to cortisol-related comorbidities  and the immunosuppressive effects of cortisol excess that may promote tumor progression . The management of ACC patients is challenging and demanding because physicians have to deal with either oncological or endocrinological issues .
Currently, the standard systemic treatment for advanced ACC patients not amenable to surgery with radical intent is mitotane, administered either alone or in combination with etoposide, doxorubicin and cisplatin (EDP-M scheme) . Mitotane exerts both adrenolytic and cytotoxic activities  and has a narrow therapeutic index defined by circulating levels of the drug between 14 and 20 mg/L . These concentrations have been...
Grant IG 2015-17678 from Associazione Italiana per la Ricerca sul Cancro (AIRC) to MT. Private grant from the amateur dramatics group “Attori non per caso”, parish church of Collio Valtrompia (Brescia) to BL.
This study was funded by Associazione Italiana per la Ricerca sul Cancro (AIRC), grant n. IG 2015-17678 to MT and by a private grant from the amateur dramatics group “Attori non per caso”, parish church of Collio Valtrompia (Brescia) to BL.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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