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Cited by 27Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersPregnancy and Medication Impact

Pregnancy in a patient with adrenal carcinoma treated with mitotane: a case report and review of literature

Tripto-Shkolnik, Liana, Blumenfeld, Zeev, Bronshtein, Moshe, Salmon, Asher, Jaffe, Anat·2013·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2012-2839
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Abstract

CONTEXT: Adrenocortical carcinoma (ACC) affects patients in a broad age group, including young women. Mitotane, an adrenolytic agent, is the mainstay of treatment after surgical removal of the tumor. There is extreme paucity of information regarding the effect of mitotane on childbearing potential and pregnancy outcome. OBJECTIVE: The aim of the study was to describe and discuss the case of an ACC patient who conceived while on mitotane treatment. Current literature is reviewed. PATIENT AND METHODS: A 33-year-old woman received mitotane treatment for 4 years due to metastatic ACC. Despite nearly therapeutic blood levels of the drug, the patient had regular menstruation and was able to conceive. Mitotane was stopped at gestation week 6. Although the drug continued to be detected in considerable amounts, the fetus developed normally, including morphologically intact adrenal glands. At gestation week 21, pregnancy was terminated due to ACC recurrence. Mitotane levels were undetectable in fetal cord blood and amniotic fluid. CONCLUSION: Our report suggests that mitotane, despite its action as an endocrine disruptor, does not affect normal gonadal function or an ability to conceive. The concern of placental transfer by this hydrophobic compound is not supported by our findings. However, we do not recommend drawing conclusions regarding the safety of mitotane in pregnancy, based on 1 or several case reports. Until more data are available, pregnancy should be avoided in women being treated with mitotane for ACC.

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  • A recent case report analyzed blood levels in a 21-week gestation normally developed fetus from a pregnancy terminated for ACC recurrence; amnion fluid and cord blood levels of mitotane were undetectable, arguing that there may be minimal exposure to the fetus.

    “A recent case report analyzed blood levels in a 21-week gestation normally developed fetus from a pregnancy terminated for ACC recurrence (309). In this study, amnion fluid and cord blood levels of mitotane were undetectable, arguing that there may be minimal exposure to the fetus.”

    From Adrenocortical carcinoma (2014) · cites this paper as [309]

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Research works printed but not linked: 2

  1. Homer L, Viatge M, Gayet FX, Laurent Y, Kerlan V. [Cushing syndrome and pregnancy: a propos of a malignant adrenocortical carcinoma]. Gynecol Obstet Fertil. 2012;40:e1-e4.
  2. Gerl H, Benecke R, Knappe G, Rohde W, Stahl F, Amendt P. Preg- nancy and partus in Cushing's disease treated with o,p'-DDD. Acta Endocrinol (Copenh). 1992;126:133.

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Authors
Tripto-Shkolnik, L., Blumenfeld, Z., Bronshtein, M., Salmon, A., & Jaffe, A.
Affiliations
  • Technion – Israel Institute of Technology (IL)
  • University of Haifa (IL)
  • Hadassah Medical Center (IL)
  • Hillel Yaffe Medical Center (IL)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2013-02
Volume
98
Issue
2
Pages
443-447
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2012-2839
OpenAlex
W2157820895
Cited by
27
References
20
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 4 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 1 · 2013: 1
FWCI
1.63
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
Tel Aviv University
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
adrenocortical carcinoma, mitotane, pregnancy, fertility, endocrine disruptors, placental transfer, fetal cord blood, amniotic fluid, drug safety in pregnancy, metastatic adrenal carcinoma, gonadal function
MeSH terms
Adrenal Cortex Neoplasms, Adult, Female, Humans, Mitotane, Pregnancy, Pregnancy Complications, Neoplastic, Fatal Outcome, Adrenocortical Carcinoma, Antineoplastic Agents, Hormonal

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