RESUMO
Adrenocortical carcinoma (ACC) is a malignant tumour that originates from the adrenal cortex. It is a highly aggressive cancer characterised by a poor prognosis with an annual incidence estimated to be up to 2 cases per million. In the adult population, ACC is diagnosed typically between 40 and 50 years of age, more often in women. Complete surgical resection of the tumour is the primary treatment method for ACC. Unfortunately, despite properly performed adrenalectomy, regional recurrences or distant metastases are detected in up to 90% of the patients. For that reason, adjuvant therapy is recommended. Mitotane is the most effective adrenal-specific agent used in adjuvant and palliative therapy. Two menstruating patients, after adrenalectomy due to ACC, during adjuvant mitotane therapy, have been included in the study. The study aimed to assess the effect of mitotane therapy on the endometrium and its clinical consequences, based on the analysis of these two cases and a review of the literature. It seems that menorrhagia may be expected during adjuvant mitotane therapy of ACC in menstruating women. Heavy uterine bleeding during menstruation may appear several months after the beginning of therapy. The likely mechanism for heavy menstrual bleeding is complex. Menorrhagia can occur due to the toxic effect of mitotane in the form of a haemorrhagic diathesis, while long-term treatment (over ten months) can lead to relative hypoestrogenism resulting in endometrial hyperplasia. Clinical signs of hypoestrogenism during mitotane treatment, have been described (including pre-puberty girls) and should be considered as a side-effect of the therapy. Menorrhagia may lead to severe anaemia, so this should be considered when planning mitotane treatment. Continuous gestagen therapy is helpful in the treatment of the above disorders. After over 60 years of experience with mitotane usage, knowledge about it is still insufficient, and further studies are required.
RESUMO
INTRODUCTION: Acromegaly is an endocrine disorder caused predominantly by pituitary adenoma leading to autonomic oversecretion of growth hormone and secondary elevation of insulin-like growth factor 1 (IGF-1). Consequently, there are both theoretical and experimental grounds for establishing a correlation between this disorder and the higher incidence of neoplasms. OBJECTIVE: The aim of the study is to evaluate the incidence and types of neoplasms among patients with acromegaly. MATERIAL AND METHODS: The study included 67 patients with acromegaly, aged between 24 and 75±18.8 years, 46 women (68.7%) and 21 men (31.3%), BMI: 30.7±5.7 kg/m2, age at diagnosis 49.1±12.5 years, with the medians of GH and IGF-1 levels at diagnosis of 11.3 ng/ml and 663.8 ng/ml, respectively. A retrospective analysis of medical records with particular regard to physical examination, medical history, laboratory and imaging tests was performed. RESULTS: Fifty-one patients (76.1%) suffered from at least one neoplasm, among whom 48 patients (71.6%) had benign proliferations, whereas malignant neoplasms (larynx, endometrial and colon cancers) were found in only three patients (4.5%). CONCLUSIONS: Benign neoplasms were found in majority of patients with acromegaly (71.6%) most notably: nodular goiter and colon polyps; malignant lesions were rare (4.5%). Only every fifth patient suffered from no neoplastic proliferations. No correlations between the studied parameters and the incidence of neoplasms were found, most likely due to the small number of patients. This is the reason for proposing the creating of the first national register of incidences of neoplasms among acromegalic patients.