Thyroid & Adrenal
Medical adrenalectomy is seen with
a. The most important predictor of survival in patients with adrenal cancer is the adequacy of resection.
b. Patients who undergo complete resection have 5-year actuarial survival rates ranging from 32 to 48%, whereas median survival is less than 1 year in those undergoing incomplete excision.
c. Therefore, adrenocortical carcinomas are treated by excision of the tumor en bloc, with any contiguously involved lymph nodes or organs, such as the diaphragm, kidney, pancreas, liver, or inferior vena cava.
d. This is best accomplished by open adrenalectomy via a generous subcostal incision or a thoracoabdominal incision (on the right side).
e. Mitotane or o, p-DDD or 1,1-dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl) ethane, which is a derivative of the insecticide DDT, has adrenolytic activity and has been used in the adjuvant setting and for the treatment of unresectable or metastatic disease.
f. Determination of blood mitotane levels is helpful to ascertain whether therapeutic and nontoxic levels are present.
g. Adrenocortical tumors commonly metastasize to the liver, lung, and bone.
h. Surgical debulking is recommended for isolated, recurrent disease and has been demonstrated to prolong survival.
i. Suramin, a growth factor inhibitor, has shown minimal partial response rates.
j. Adrenocortical cancers are also relatively insensitive to conventional external beam radiation therapy. However, this modality is used in the palliation of bony metastases.
k. Ketoconazole, metyrapone, or aminoglutethimide may also be useful in controlling steroid hypersecretion.