{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:53Z","timestamp":1784557073931,"version":"3.55.0"},"reference-count":6,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"\n Summary<\/jats:title>\n Mitotane is used for treatment of advanced adrenocortical carcinoma. It is administered when the carcinoma is unresectable, metastasized, or at high-risk of recurrence after resection. In addition, mitotane is considered to have direct adrenolytic effects. Because of its narrow therapeutic\u2013toxic range, therapeutic drug monitoring (TDM) is warranted. In 2020, a left-sided adrenal gland tumor was found (5.8 cm) in a 38-year-old man. Considering the size of this lesion and inability to exclude an adrenocortical carcinoma on imaging, a laparoscopic adrenalectomy was performed. Histopathologic examination determined presence of an adrenocortical carcinoma (pT2N0M0 ENSAT stadium II; ki67 10\u201315%). There was no evidence for residual or metastatic disease but given the high risk of recurrence, adjuvant therapy with mitotane was initiated. During TDM, a sudden and spuriously high level of mitotane was observed but without signs or symptoms of toxicity. After exploration, it was found that this high concentration was completely due to uncontrolled hypertriglyceridemia. After correction thereof, mitotane levels were again in the therapeutic range. This observation underscores the importance of TDM sampling in a fasting state with concurrent control of prevalent or incident dyslipidemia.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n TDM of mitotane is advocated to achieve therapeutic levels while avoiding toxicity. For correct TDM, sampling should be done at least 12 h after last intake of mitotane.<\/jats:p>\n <\/jats:list-item>\n \n Although sampling in fasting conditions in not explicitly mentioned in the guidelines, fasting state should be considered as elevated serum triglyceride levels might cause spuriously high mitotane levels.<\/jats:p>\n <\/jats:list-item>\n \n In patients undergoing treatment with mitotane and presenting with too high or unexplained fluctuating mitotane levels without signs or symptoms of toxicity, hypertriglyceridemia as a possible cause should be investigated.<\/jats:p>\n <\/jats:list-item>\n \n If dyslipidemia occurs in patients under mitotane treatment, other causes than mitotane (e.g. alcohol abuse and diabetes) should be considered and appropriate treatment should be initiated.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-23-0014","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T07:28:52Z","timestamp":1701847732000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Hypertriglyceridemia and its impact on mitotane monitoring in adrenocortical carcinoma"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7576-7674","authenticated-orcid":true,"given":"Sandra","family":"Martens","sequence":"first","affiliation":[{"name":"Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1584-4965","authenticated-orcid":true,"given":"Bruno","family":"Lapauw","sequence":"additional","affiliation":[{"name":"Ghent University Hospital, Ghent, Belgium"},{"name":"Ghent University, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Endocrine Reviews","first-page":"282","article-title":"Adrenocortical carcinoma","volume":"35","author":"Else","year":"2013","unstructured":"Else T, Kim AGSabolch ARaymond VMKandathil ACaoili EMJolly SMiller BSGiordano TJ & Hammer GD. Adrenocortical carcinoma. Endocrine Reviews201335282\u2013326. (https:\/\/doi.org\/10.1210\/er.2013-1029)"},{"key":"bib2","series-title":"European Journal of Endocrinology","first-page":"G1","article-title":"European society of endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"179","author":"Fassnacht","year":"2018","unstructured":"Fassnacht MDekkers OMElse TBaudin EBerruti Ade Krijger RHaak HRMihai RAssie G & Terzolo M. European society of endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology2018179G1\u2013G46. (https:\/\/doi.org\/10.1530\/EJE-18-0608)"},{"key":"bib3","series-title":"Cancer Chemotherapy and Pharmacology","first-page":"331","article-title":"The distribution of o,p\u2019-DDD (mitotane) among serum lipoproteins in normo- and hypertriglyceridemia","volume":"29","author":"Gebhardt","year":"1992","unstructured":"Gebhardt DOMoolenaar AJvan Seters APvan der Velde EA & Gevers Leuven JA. The distribution of o,p\u2019-DDD (mitotane) among serum lipoproteins in normo- and hypertriglyceridemia. Cancer Chemotherapy and Pharmacology199229331\u2013334. (https:\/\/doi.org\/10.1007\/BF00685956)"},{"key":"bib4","series-title":"Hormone and Metabolic Research","first-page":"240","article-title":"Mitotane (o,p\u2019-DDD) administration raises the serum level of high density lipoprotein (HDL) in normotriglyceridemia","volume":"25","author":"Gebhardt","year":"1993","unstructured":"Gebhardt DOMoolenaar AJ & van Seters AP. 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(https:\/\/doi.org\/10.1530\/EJE-15-0946)"},{"key":"bib6","series-title":"International Journal of Endocrinology","first-page":"624962","article-title":"Mitotane-induced hyperlipidemia: a retrospective cohort study","volume":"2013","author":"Shawa","year":"2013","unstructured":"Shawa HDeniz FBazerbashi HHernandez MVassilopoulou-Sellin RJimenez C & Habra MA. Mitotane-induced hyperlipidemia: a retrospective cohort study. International Journal of Endocrinology20132013624962. (https:\/\/doi.org\/10.1155\/2013\/624962)"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2023\/4\/EDM23-0014.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2023\/4\/EDM23-0014.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2023\/4\/EDM23-0014.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:11Z","timestamp":1784555291000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":6,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1530\/edm-23-0014","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}