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Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review

SIMPLE SUMMARY: This is, to our knowledge, the first systematic review conducted on the endocrine effects of mitotane, which aims to collect all available evidence in the literature and provide complete and useful information regarding the management of the endocrine and metabolic side effects of mi...

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Autores principales: Bianchini, Marta, Puliani, Giulia, Chiefari, Alfonsina, Mormando, Marilda, Lauretta, Rosa, Appetecchia, Marialuisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508479/
https://www.ncbi.nlm.nih.gov/pubmed/34638485
http://dx.doi.org/10.3390/cancers13195001
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author Bianchini, Marta
Puliani, Giulia
Chiefari, Alfonsina
Mormando, Marilda
Lauretta, Rosa
Appetecchia, Marialuisa
author_facet Bianchini, Marta
Puliani, Giulia
Chiefari, Alfonsina
Mormando, Marilda
Lauretta, Rosa
Appetecchia, Marialuisa
author_sort Bianchini, Marta
collection PubMed
description SIMPLE SUMMARY: This is, to our knowledge, the first systematic review conducted on the endocrine effects of mitotane, which aims to collect all available evidence in the literature and provide complete and useful information regarding the management of the endocrine and metabolic side effects of mitotane in clinical practice. ABSTRACT: Despite the pivotal role of mitotane in adrenocortical carcinoma (ACC) management, data on the endocrine toxicities of this treatment are lacking. The aim of this systematic review is to collect the available evidence on the side effects of mitotane on the endocrine and metabolic systems in both children and adults affected by adrenal carcinoma. Sixteen articles on 493 patients were included. Among the adrenal insufficiency, which is an expected side effect of mitotane, 24.5% of patients increased glucocorticoid replacement therapy. Mineralocorticoid insufficiency usually occurred late in treatment in 36.8% of patients. Thyroid dysfunction is characterized by a decrease in FT4, which occurs within 3–6 months of treatment in 45.4% of patients, while TSH seems to not be a reliable marker. Dyslipidemia is characterized by an increase in both LDL-c and HDL-c (54.2%). Few studies have found evidence of hypertriglyceridemia. In males, gynecomastia and hypogonadism can occur after 3–6 months of treatment (38.4% and 35.6%, respectively), while in pre-menopausal women, mitotane can cause ovarian cysts and, less frequently, menstrual disorders. Most of these side effects appear to be reversible after mitotane discontinuation. We finally suggest an algorithm that could guide metabolic and endocrine safety assessments in patients treated with mitotane for ACC.
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spelling pubmed-85084792021-10-13 Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review Bianchini, Marta Puliani, Giulia Chiefari, Alfonsina Mormando, Marilda Lauretta, Rosa Appetecchia, Marialuisa Cancers (Basel) Systematic Review SIMPLE SUMMARY: This is, to our knowledge, the first systematic review conducted on the endocrine effects of mitotane, which aims to collect all available evidence in the literature and provide complete and useful information regarding the management of the endocrine and metabolic side effects of mitotane in clinical practice. ABSTRACT: Despite the pivotal role of mitotane in adrenocortical carcinoma (ACC) management, data on the endocrine toxicities of this treatment are lacking. The aim of this systematic review is to collect the available evidence on the side effects of mitotane on the endocrine and metabolic systems in both children and adults affected by adrenal carcinoma. Sixteen articles on 493 patients were included. Among the adrenal insufficiency, which is an expected side effect of mitotane, 24.5% of patients increased glucocorticoid replacement therapy. Mineralocorticoid insufficiency usually occurred late in treatment in 36.8% of patients. Thyroid dysfunction is characterized by a decrease in FT4, which occurs within 3–6 months of treatment in 45.4% of patients, while TSH seems to not be a reliable marker. Dyslipidemia is characterized by an increase in both LDL-c and HDL-c (54.2%). Few studies have found evidence of hypertriglyceridemia. In males, gynecomastia and hypogonadism can occur after 3–6 months of treatment (38.4% and 35.6%, respectively), while in pre-menopausal women, mitotane can cause ovarian cysts and, less frequently, menstrual disorders. Most of these side effects appear to be reversible after mitotane discontinuation. We finally suggest an algorithm that could guide metabolic and endocrine safety assessments in patients treated with mitotane for ACC. MDPI 2021-10-05 /pmc/articles/PMC8508479/ /pubmed/34638485 http://dx.doi.org/10.3390/cancers13195001 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Bianchini, Marta
Puliani, Giulia
Chiefari, Alfonsina
Mormando, Marilda
Lauretta, Rosa
Appetecchia, Marialuisa
Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title_full Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title_fullStr Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title_full_unstemmed Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title_short Metabolic and Endocrine Toxicities of Mitotane: A Systematic Review
title_sort metabolic and endocrine toxicities of mitotane: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508479/
https://www.ncbi.nlm.nih.gov/pubmed/34638485
http://dx.doi.org/10.3390/cancers13195001
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