Influence of Plasma Triglyceride Levels on Plasma Mitotane Concentrations in a Patient with Adrenocortical Carcinoma: A Case Report

Adrenocortical carcinoma (ACC) is a rare and aggressive cancer of the adrenal cortex. The first-line treatment for patients with advanced/metastatic disease is mitotane, either as monotherapy or in combination with chemotherapy. Mitotane is an adrenolytic drug with low aqueous solubility and a high volume of distribution, with adipose tissue being its primary site of distribution. This leads to high inter- and intra-individual variability in bioavailability, highlighting the need for monitoring plasma concentrations. We present the case of a 50-year-old man with metastatic ACC. Oral mitotane treatment was initiated, and abrupt variations in plasma concentrations were observed despite consistent dosing. Subsequently, supratherapeutic concentrations were found to coincide with elevated triglyceride levels, prompting a complete lipid profile to be requested after each monitoring session. This case underscores the importance of monitoring dyslipidemia in patients undergoing mitotane therapy.