Management of Severe Cushing Syndrome Induced by Adrenocortical Carcinoma with Abiraterone Acetate: A Case Report

Mélanie Claps, MD; Barbara Lazzari, MD; Salvatore. Grisanti, MD; Vittorio Ferrari, MD; Massimo Terzolo, MD; Sandra Sigala, MD; Sara Vezzoli, MD; Maurizio Memo, MD; Maurizio Castellano, MD; Alfredo Berruti, MD

AACE Clinical Case Reports (Jan 2016)

Management of Severe Cushing Syndrome Induced by Adrenocortical Carcinoma with Abiraterone Acetate: A Case Report

Mélanie Claps, MD,
Barbara Lazzari, MD,
Salvatore. Grisanti, MD,
Vittorio Ferrari, MD,
Massimo Terzolo, MD,
Sandra Sigala, MD,
Sara Vezzoli, MD,
Maurizio Memo, MD,
Maurizio Castellano, MD,
Alfredo Berruti, MD

Affiliations

Mélanie Claps, MD: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
Barbara Lazzari, MD: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
Salvatore. Grisanti, MD: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
Vittorio Ferrari, MD: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
Massimo Terzolo, MD: Department of Clinical and Biological Sciences, Internal Medicine, University of Turin at San Luigi Hospital, Orbassano, Italy
Sandra Sigala, MD: Department of Molecular and Translational Sciences, Section of Pharmacology and Center for Drug Innovation Forward Future (DIFF), University of Brescia, Brescia, Italy
Sara Vezzoli, MD: Department of Molecular and Translational Sciences, Section of Pharmacology and Center for Drug Innovation Forward Future (DIFF), University of Brescia, Brescia, Italy
Maurizio Memo, MD: Department of Molecular and Translational Sciences, Section of Pharmacology and Center for Drug Innovation Forward Future (DIFF), University of Brescia, Brescia, Italy
Maurizio Castellano, MD: Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Internal Medicine, University of Brescia, Spedali Civili Hospital, Brescia, Italy.
Alfredo Berruti, MD: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy; Address correspondence to Dr. Alfredo Berruti, Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Piazzale Spedali Civili, 1 - 25123 Brescia, Italy. E-mail:

Journal volume & issue: Vol. 2, no. 4
pp. e337 – e341

Abstract

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ABSTRACT: Objective: Adrenocortical carcinoma (ACC) is a rare disease often associated with hormonal hypersecretion. Hypercortisolism is the most common endocrine syndrome associated with ACC. Abiraterone acetate is a selective and irreversible inhibitor of cytochrome P450 17A1 that is currently used in the treatment of metastatic castration-resistant prostate cancer. The drug induces a profound suppression of both androgen and cortisol secretion and it is a plausible candidate for medical treatment of Cushing's syndrome. We evaluated the hormonal effects of abiraterone administration in a patient with Cushing's syndrome induced by heavily pre-treated metastatic ACC.Methods: A 50-year-old woman with ACC, suffering from severe and unmanageable Cushing's syndrome despite mitotane therapy, received oral abiraterone at 500 mg/day.Results: After 9 days of treatment, the patient experienced a dramatic improvement in autonomy and deambulation, reduction of edema, better control of blood pressure and glycemia, serum potassium normalization, restoration of the sleep-wake rhythm, and disappearance of mental confusion episodes. Hormonal laboratory tests showed a marked reduction in circulating androgen levels and urinary cortisol excretion (urinary free cortisol levels lowered from 1,863 to 520 μg/24 h). Abiraterone therapy was interrupted due to subsequent deterioration of the patient's condition caused by the progression of ACC.Conclusions: Abiraterone can be an effective medical treatment in the management of Cushing's syndrome induced by ACC. This preliminary observation warrants confirmation in a prospective clinical trial.Abbreviations: ACC = adrenocortical carcinoma

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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