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1. Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP: Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer; 2005 Sep;12(3):667-80
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of patients with adrenal cancer: recommendations of an international consensus conference.
  • Adrenocortical carcinomas are rare, highly malignant tumors that account for only 0.2% of deaths due to cancer.
  • Given the limited number of patients seen in most medical centers with this diagnosis, series usually reported are small and clinical trials not randomized or blinded.
  • In an attempt to answer important questions concerning the management of patients with adrenal cancer, a consensus conference was organized and held at the University of Michigan in Ann Arbor, MI, 11-13 September 2003, with the participation of an international group of physicians who had reported on the largest series of patients with this disease and who had recognized basic and clinical research expertise in adrenal cortical cancer.
  • In addition to setting up guidelines in specific areas of the diagnosis and treatment of adrenal cancer, the conference recommended and initiated the planning of an international prospective trial for treatment of patients with adrenal cancer in stages III and IV.
  • In terms of new therapies, first trials of dendritic cell therapy in human subjects with adrenal cancer have been started, but it is too early to comment on efficacy.
  • There are no clinical gene therapy trials for human adrenal cortical cancer.
  • The adrenals are a preferred target for adenovirus and the results of gene therapy in preclinical studies are promising.
  • In addition, there is evidence that histone deacetylase inhibitors can further enhance the rate of adenoviral infectivity in human adrenal cancer cells.
  • The use of these and other agents in the treatment of adrenal cancer should be hypothesis-driven and based on a thorough analysis of tumor biology.
  • [MeSH-major] Adrenal Gland Neoplasms / therapy
  • [MeSH-minor] Humans. Neoplasm Staging

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  • (PMID = 16172199.001).
  • [ISSN] 1351-0088
  • [Journal-full-title] Endocrine-related cancer
  • [ISO-abbreviation] Endocr. Relat. Cancer
  • [Language] eng
  • [Grant] United States / NCRR NIH HHS / RR / M 01-RR000 42
  • [Publication-type] Consensus Development Conference; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review
  • [Publication-country] England
  • [Number-of-references] 75
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2. Fassnacht M, Hahner S, Hansen IA, Kreutzberger T, Zink M, Adermann K, Jakob F, Troppmair J, Allolio B: N-terminal proopiomelanocortin acts as a mitogen in adrenocortical tumor cells and decreases adrenal steroidogenesis. J Clin Endocrinol Metab; 2003 May;88(5):2171-9
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  • [Title] N-terminal proopiomelanocortin acts as a mitogen in adrenocortical tumor cells and decreases adrenal steroidogenesis.
  • There is evidence that proopiomelanocortin (POMC)-derived peptides other than ACTH are involved in pituitary-dependent adrenal growth.
  • We have synthesized the human N-terminal POMC fragment 1-28-POMC with the disulfide bridges in the correct position between cysteine residues 2-24 and 8-20 and studied the activity of these peptides in adrenocortical tumor cells in vitro.
  • 1-28-POMC stimulated cell proliferation in human NCI-h295 and mouse Y-1 adrenal cancer cell lines and also in primary cultures of bovine adrenocortical cells in a concentration-dependent manner.
  • However, protein levels of important regulators of steroidogenesis [steroidogenic factor-1, DAX-1 (dosage-sensitive sex reversal-adrenal hypoplasia congenita critical region on the X-chromosome 1), steroidogenic acute regulatory protein, and cytochrome P450 side-chain cleavage enzyme] remained unaffected by 1-28-POMC treatment.
  • Our results provide evidence that synthetic 1-28-POMC induces adrenal tumor cell proliferation, inhibits adrenal steroidogenesis, and mediates its action by signaling via the extracellular signal-regulated kinase pathway.
  • The distinct roles of 1-28-POMC and ACTH in the regulation of adrenal growth and steroidogenesis suggest that the adrenal cortex is under the dual opposing control of fragments from the same mother peptide POMC.
  • [MeSH-major] Adrenal Cortex Hormones / biosynthesis. Adrenal Cortex Neoplasms / metabolism. Adrenal Cortex Neoplasms / pathology. Mitogens / pharmacology. Peptide Fragments / pharmacology. Pro-Opiomelanocortin / pharmacology
  • [MeSH-minor] 17-alpha-Hydroxyprogesterone / metabolism. Adrenal Cortex / drug effects. Animals. Cattle. Cell Division / drug effects. Cells, Cultured. Dehydroepiandrosterone Sulfate / metabolism. Enzyme Activation / drug effects. Humans. Hydrocortisone / biosynthesis. JNK Mitogen-Activated Protein Kinases. Mice. Mitogen-Activated Protein Kinase 1 / metabolism. Mitogen-Activated Protein Kinase 3. Mitogen-Activated Protein Kinases / metabolism. Phosphorylation. Signal Transduction. Tumor Cells, Cultured. p38 Mitogen-Activated Protein Kinases

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  • (PMID = 12727972.001).
  • [ISSN] 0021-972X
  • [Journal-full-title] The Journal of clinical endocrinology and metabolism
  • [ISO-abbreviation] J. Clin. Endocrinol. Metab.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Adrenal Cortex Hormones; 0 / Mitogens; 0 / Peptide Fragments; 57B09Q7FJR / Dehydroepiandrosterone Sulfate; 66796-54-1 / Pro-Opiomelanocortin; 68-96-2 / 17-alpha-Hydroxyprogesterone; EC 2.7.11.24 / JNK Mitogen-Activated Protein Kinases; EC 2.7.11.24 / Mitogen-Activated Protein Kinase 1; EC 2.7.11.24 / Mitogen-Activated Protein Kinase 3; EC 2.7.11.24 / Mitogen-Activated Protein Kinases; EC 2.7.11.24 / p38 Mitogen-Activated Protein Kinases; WI4X0X7BPJ / Hydrocortisone
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3. Schteingart DE: Conventional and novel strategies in the treatment of adrenocortical cancer. Braz J Med Biol Res; 2000 Oct;33(10):1197-200
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  • [Title] Conventional and novel strategies in the treatment of adrenocortical cancer.
  • Adrenocortical carcinoma is a highly malignant neoplasm with an incidence of two per million people per year.
  • Several treatment strategies have resulted in temporary or partial tumor regression but very few cases have attained long survival.
  • Surgical resection of the primary tumor and metastases is most effective.
  • Mitotane (o,p'-DDD) is an adrenalytic drug effective in inducing a tumor response in 33% of patients treated.
  • Tumors may vary in their ability to metabolize mitotane and the ability of tumors to transform mitotane may predict the clinical response to the drug.
  • Future approaches to the treatment of adrenocortical carcinoma are likely to be based on blocking or reversing the biological mechanisms of tumorigenesis.
  • Angiogenic and chemotactic mechanisms may play a role in adrenal tumor growth and inhibition of these mechanisms may result in inhibition of tumor growth.
  • New mitotane analogs with greater adrenalytic potential could be a promising approach to developing more effective and selective therapies for adrenal cancer.
  • Alternative approaches should attempt to suppress tumor growth by means of compounds with anti-angiogenic and anti-chemotactic activity.

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  • (PMID = 11004720.001).
  • [ISSN] 0100-879X
  • [Journal-full-title] Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
  • [ISO-abbreviation] Braz. J. Med. Biol. Res.
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] Brazil
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 78E4J5IB5J / Mitotane
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4. Schteingart DE, Benitez R, Bradford C, Narayan A, Wang S: Expression of anti-apoptosis genes determines the response of adrenal cancer to apoptosis-inducing chemotherapy. Anticancer Res; 2010 Dec;30(12):4805-9
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  • [Title] Expression of anti-apoptosis genes determines the response of adrenal cancer to apoptosis-inducing chemotherapy.
  • BACKGROUND: This study tested the hypothesis that response of adrenal cortical carcinoma (ACC) to pro-apoptosis drugs depends on expression of anti-apoptosis genes.
  • MATERIALS AND METHODS: Expression of Bcl-2 and Bcl-XL proteins was determined in two human adrenal cancer cell lines, NCI-H-295 and RL-251.
  • Two pro-apoptosis drugs, gossypol (G) and docetaxel (D) were tested in vitro and in vivo in a human ACC/SCID mouse chimera.
  • CONCLUSION: This study provided proof of concept that expression of Bcl-XL determines response to pro-apoptosis drugs.
  • Profiling adrenal tumors for expression of anti-apoptosis genes may provide clues to their potential response to drugs that induce apoptosis.
  • [MeSH-major] Adrenal Cortex Neoplasms / drug therapy. Adrenal Cortex Neoplasms / genetics. Apoptosis / drug effects. Apoptosis / genetics. Proto-Oncogene Proteins c-bcl-2 / biosynthesis. bcl-X Protein / biosynthesis
  • [MeSH-minor] Animals. Cell Line, Tumor. Genes, bcl-2. Gossypol / pharmacology. Humans. Mice. Mice, SCID. Taxoids / pharmacology

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  • (PMID = 21187456.001).
  • [ISSN] 1791-7530
  • [Journal-full-title] Anticancer research
  • [ISO-abbreviation] Anticancer Res.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / BCL2L1 protein, human; 0 / Proto-Oncogene Proteins c-bcl-2; 0 / Taxoids; 0 / bcl-X Protein; 15H5577CQD / docetaxel; KAV15B369O / Gossypol
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5. Gross MD, Korobkin M, Bou-Assaly W, Rubello D: Incidentally-discovered adrenal masses. Discov Med; 2010 Jan;9(44):24-33
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  • [Title] Incidentally-discovered adrenal masses.
  • Unanticipated adrenal masses are frequently encountered in modern, high resolution diagnostic imaging.
  • Most often, these masses are benign adrenal adenomas, but when detected they necessitate a clinical evaluation sufficient to exclude subclinical endocrine disease, primary adrenal cancer, and remote metastases to the adrenal glands from other malignancies.
  • These "incidentally-discovered" adrenal masses or so-called "adrenal incidentalomas" can be further evaluated with CT, MRI, and nuclear medicine imaging techniques.
  • A substantial literature supports the use of each of these modalities to non-invasively characterize these neoplasms that have been considered by some as a 'disease' of modern imaging technology.
  • [MeSH-major] Adrenal Gland Diseases / diagnosis
  • [MeSH-minor] Adrenal Gland Neoplasms / diagnosis. Humans. Incidental Findings. Magnetic Resonance Imaging. Tomography, X-Ray Computed

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  • (PMID = 20102682.001).
  • [ISSN] 1944-7930
  • [Journal-full-title] Discovery medicine
  • [ISO-abbreviation] Discov Med
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 18
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6. Butler C, Butler WM, Rizvi AA: Sustained remission with the kinase inhibitor sorafenib in stage IV metastatic adrenocortical carcinoma. Endocr Pract; 2010 May-Jun;16(3):441-5
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  • [Title] Sustained remission with the kinase inhibitor sorafenib in stage IV metastatic adrenocortical carcinoma.
  • An 8-cm left adrenal lesion was found on computed tomography, removed surgically, and confirmed as adrenal carcinoma on pathologic examination.
  • Postoperative scanning revealed metastases to both lungs and the liver that were confirmed by fine-needle biopsy, thus establishing stage IV disease.
  • Treatment with the adrenolytic agent mitotane failed to halt disease progression.
  • CONCLUSION: Multiple kinase inhibitors such as sorafenib provide targeted oncologic treatment and may be effective in treating advanced adrenal cancer.

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  • (PMID = 20061282.001).
  • [ISSN] 1934-2403
  • [Journal-full-title] Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
  • [ISO-abbreviation] Endocr Pract
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Benzenesulfonates; 0 / Phenylurea Compounds; 0 / Protein Kinase Inhibitors; 0 / Pyridines; 25X51I8RD4 / Niacinamide; 9ZOQ3TZI87 / sorafenib
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7. Kato M, Higashihara E: [Urological cancer]. Gan To Kagaku Ryoho; 2005 Sep;32(9):1255-9
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  • [Title] [Urological cancer].
  • We reported laparoscopic adrenalectomy for adrenal cancer, our experience of laparoscopic partial nephrectomy, radical prostatectomy, retroperitoneal lymph node dissection for testicular cancer.
  • Minimally invasive therapy is the direction of progress in current clinical medicine, so laparoscopic procedures have developed and their application has expanded in the urological field.
  • [MeSH-major] Laparoscopy. Lymph Node Excision. Minimally Invasive Surgical Procedures. Urologic Neoplasms / surgery
  • [MeSH-minor] Adrenal Gland Neoplasms / surgery. Adrenalectomy. Female. Humans. Kidney Neoplasms / surgery. Male. Nephrectomy. Prostatectomy. Prostatic Neoplasms / surgery. Testicular Neoplasms / surgery. Urinary Bladder Neoplasms / surgery

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  • (PMID = 16184920.001).
  • [ISSN] 0385-0684
  • [Journal-full-title] Gan to kagaku ryoho. Cancer & chemotherapy
  • [ISO-abbreviation] Gan To Kagaku Ryoho
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Japan
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8. Kanczkowski W, Tymoszuk P, Ehrhart-Bornstein M, Wirth MP, Zacharowski K, Bornstein SR: Abrogation of TLR4 and CD14 expression and signaling in human adrenocortical tumors. J Clin Endocrinol Metab; 2010 Dec;95(12):E421-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • CONTEXT: Adrenocortical carcinoma (ACC) is a rare tumor with poor prognosis.
  • The expression of innate immunity receptor Toll-like receptor 4 (TLR4) was recently reported in various human tumors, and TLR4 was shown to regulate tumor immune escape processes, proliferation, and resistance to chemotherapeutical agents.
  • OBJECTIVE: The aim of this study was to investigate TLR4 expression, signaling, and function in the process of tumorigenesis in the human adrenal cortex.
  • MEASUREMENTS AND MAIN RESULTS: Real-time PCR analysis of human ACC (n=8), adenoma (n=8), and ACC cell lines (SW13, NCI-H295R, and HAC15) revealed a significant down-regulation of TLR4, MD2 (myeloid differentiation protein-2), and cluster of differentiation 14 (CD14) mRNA compared with normal human adrenal cortex and adrenocortical cells in primary culture.
  • Furthermore, our data show that reintroduction of TLR4 expression in ACCs may provide a novel therapeutic strategy for adrenal cancer.
  • [MeSH-major] Adrenal Cortex Neoplasms / genetics. Antigens, CD14 / genetics. Toll-Like Receptor 4 / genetics
  • [MeSH-minor] Adenoma / genetics. Adenoma / pathology. Adrenal Cortex / pathology. Adrenal Cortex / physiology. Adult. Animals. Blotting, Western. Cell Division. Cell Line, Tumor. Down-Regulation. Female. Gene Expression Regulation. Humans. Immunohistochemistry. Male. Middle Aged. Polymerase Chain Reaction / methods. RNA, Messenger / genetics. Reference Values


9. Wu PP, Kuo SC, Huang WW, Yang JS, Lai KC, Chen HJ, Lin KL, Chiu YJ, Huang LJ, Chung JG: (-)-Epigallocatechin gallate induced apoptosis in human adrenal cancer NCI-H295 cells through caspase-dependent and caspase-independent pathway. Anticancer Res; 2009 Apr;29(4):1435-42
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  • [Title] (-)-Epigallocatechin gallate induced apoptosis in human adrenal cancer NCI-H295 cells through caspase-dependent and caspase-independent pathway.
  • (-)-Epigallocatechin-3-gallate (EGCG) is a major constituent of green tea and has been identified as an excellent anticancer agent.
  • Nevertheless, there are no reports to date about the molecular mechanisms and signal pathways of EGCG on the induction of apoptosis in human adrenal NCI-H295 cancer cells.
  • The purpose of this study was to investigate the anticancer effect and molecular mechanisms of EGCG on human adrenal NCI-H295 cancer cells.
  • When NCI-H295 cells were treated with 20 microM EGCG, the mitochondrial membrane potential decreased and intracellular free Ca(2+) increased in a time-dependent manner as analysed by flow cytometry.
  • Based on the above findings, it was confirmed that EGCG may be a drug candidate for the treatment of human adrenal cancer in the future.
  • [MeSH-major] Adrenal Gland Neoplasms / drug therapy. Adrenal Gland Neoplasms / pathology. Anticarcinogenic Agents / pharmacology. Apoptosis / drug effects. Caspases / metabolism. Catechin / analogs & derivatives
  • [MeSH-minor] Blotting, Western. Calcium / metabolism. Flow Cytometry. Humans. Membrane Potential, Mitochondrial / drug effects. Protease Inhibitors / pharmacology. Tumor Cells, Cultured


10. Luciani P, Ferruzzi P, Arnaldi G, Crescioli C, Benvenuti S, Nesi G, Valeri A, Greeve I, Serio M, Mannelli M, Peri A: Expression of the novel adrenocorticotropin-responsive gene selective Alzheimer's disease indicator-1 in the normal adrenal cortex and in adrenocortical adenomas and carcinomas. J Clin Endocrinol Metab; 2004 Mar;89(3):1332-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Expression of the novel adrenocorticotropin-responsive gene selective Alzheimer's disease indicator-1 in the normal adrenal cortex and in adrenocortical adenomas and carcinomas.
  • In the adrenal cortex, increased expression of seladin-1/DHCR24, which appears to be modulated by ACTH, has been recently reported in cortisol-secreting adenomas, compared with the adjacent atrophic tissue.
  • In our study, we measured the expression level of seladin-1/DHCR24 in cortisol- (n = 18) and aldosterone-secreting (n = 16) adrenocortical adenomas, in carcinomas (n = 17), and in normal adrenal glands (n = 8) by quantitative real-time RT-PCR.
  • Similarly, in adrenal malignancies, significantly reduced levels of expression of the ACTH receptor gene were found.
  • In the adrenal cancer cell line H295R and in primary cultures from adrenocortical cells, ACTH (1 nM) and forskolin (10 micro M) effectively increased seladin-1/DHCR24 expression, confirming that seladin-1/DHCR24 is modulated by the ACTH/cAMP-driven pathway.
  • In summary, this is the first demonstration that seladin-1/DHCR24 expression is reduced in adrenal cancer, suggesting that it might be viewed as a new potential marker of adrenal malignancies.
  • [MeSH-major] Adrenal Cortex / physiology. Adrenal Cortex Neoplasms / physiopathology. Adrenocortical Adenoma / physiopathology. Nerve Tissue Proteins / genetics. Oxidoreductases Acting on CH-CH Group Donors / genetics
  • [MeSH-minor] Adolescent. Adrenocorticotropic Hormone / pharmacology. Adult. Aged. Cell Line, Tumor. Colforsin / pharmacology. Female. Gene Expression Regulation, Enzymologic / drug effects. Gene Expression Regulation, Enzymologic / physiology. Gene Expression Regulation, Neoplastic / drug effects. Gene Expression Regulation, Neoplastic / physiology. Humans. Male. Middle Aged. RNA, Messenger / analysis. Receptors, Corticotropin / genetics

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  • (PMID = 15001630.001).
  • [ISSN] 0021-972X
  • [Journal-full-title] The Journal of clinical endocrinology and metabolism
  • [ISO-abbreviation] J. Clin. Endocrinol. Metab.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Nerve Tissue Proteins; 0 / RNA, Messenger; 0 / Receptors, Corticotropin; 1F7A44V6OU / Colforsin; 9002-60-2 / Adrenocorticotropic Hormone; EC 1.3.- / Oxidoreductases Acting on CH-CH Group Donors; EC 1.3.1.- / 3beta-hydroxysterol delta24-reductase; EC 1.3.1.- / DHCR24 protein, human
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11. Mitsiades CS, Mitsiades NS, McMullan CJ, Poulaki V, Shringarpure R, Akiyama M, Hideshima T, Chauhan D, Joseph M, Libermann TA, García-Echeverría C, Pearson MA, Hofmann F, Anderson KC, Kung AL: Inhibition of the insulin-like growth factor receptor-1 tyrosine kinase activity as a therapeutic strategy for multiple myeloma, other hematologic malignancies, and solid tumors. Cancer Cell; 2004 Mar;5(3):221-30
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Insulin-like growth factors and their receptor (IGF-1R) have been implicated in cancer pathophysiology.
  • We demonstrate that IGF-1R is universally expressed in various hematologic (multiple myeloma, lymphoma, leukemia) and solid tumor (breast, prostate, lung, colon, thyroid, renal, adrenal cancer, retinoblastoma, and sarcoma) cells.
  • Specific IGF-1R inhibition with neutralizing antibody, antagonistic peptide, or the selective kinase inhibitor NVP-ADW742 has in vitro activity against diverse tumor cell types (particularly multiple myeloma), even those resistant to conventional therapies, and triggers pleiotropic antiproliferative/proapoptotic molecular sequelae, delineated by global transcriptional and proteomic profiling.
  • NVP-ADW742 monotherapy or its combination with cytotoxic chemotherapy had significant antitumor activity in an orthotopic xenograft MM model, providing in vivo proof of principle for therapeutic use of selective IGF-1R inhibitors in cancer.
  • [MeSH-major] Hematologic Neoplasms / metabolism. Insulin-Like Growth Factor I / metabolism. Receptor, IGF Type 1 / antagonists & inhibitors. Receptor, IGF Type 1 / metabolism
  • [MeSH-minor] Antineoplastic Agents. Bone Marrow / metabolism. Enzyme Inhibitors / pharmacology. Flow Cytometry. Gene Expression Profiling. Humans. Multiple Myeloma. Neoplasms / drug therapy. Neoplasms / metabolism. Pyrimidines / pharmacology. Pyrroles / pharmacology. Transplantation, Heterologous / pathology. Vascular Endothelial Growth Factor A / metabolism

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  • (PMID = 15050914.001).
  • [ISSN] 1535-6108
  • [Journal-full-title] Cancer cell
  • [ISO-abbreviation] Cancer Cell
  • [Language] eng
  • [Grant] United States / PHS HHS / / P0-1 78378; United States / PHS HHS / / R0-1 50947
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / ADW 742; 0 / Antineoplastic Agents; 0 / Enzyme Inhibitors; 0 / Pyrimidines; 0 / Pyrroles; 0 / Vascular Endothelial Growth Factor A; 67763-96-6 / Insulin-Like Growth Factor I; EC 2.7.10.1 / Receptor, IGF Type 1
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12. Strosberg JR, Hammer GD, Doherty GM: Management of adrenocortical carcinoma. J Natl Compr Canc Netw; 2009 Jul;7(7):752-8; quiz 759
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Adrenocortical carcinomas (ACCs) are rare tumors that arise from the cortex of the adrenal gland with an incidence 1 to 2 per million.
  • The rarity of this tumor translates into a paucity of experience in managing patients in most medical centers.
  • This article describes the basic diagnostic and prognostic issues in adrenal cancer management, and presents detailed rationales for therapeutic management.
  • [MeSH-major] Adrenal Cortex Neoplasms / therapy. Adrenocortical Carcinoma / therapy
  • [MeSH-minor] Antineoplastic Agents, Hormonal / therapeutic use. Catecholamines / analysis. Chemotherapy, Adjuvant. Cushing Syndrome / drug therapy. Cushing Syndrome / etiology. Diagnostic Imaging. Humans. Hydrocortisone / analysis. Metanephrine / analysis. Mitotane / therapeutic use. Neoplasm Metastasis. Neoplasm Staging. Prognosis

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  • (PMID = 19635227.001).
  • [ISSN] 1540-1405
  • [Journal-full-title] Journal of the National Comprehensive Cancer Network : JNCCN
  • [ISO-abbreviation] J Natl Compr Canc Netw
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Catecholamines; 5001-33-2 / Metanephrine; 78E4J5IB5J / Mitotane; WI4X0X7BPJ / Hydrocortisone
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13. Fitzgerald PJ: Is norepinephrine an etiological factor in some types of cancer? Int J Cancer; 2009 Jan 15;124(2):257-63
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  • [Title] Is norepinephrine an etiological factor in some types of cancer?
  • I examine evidence that the signaling molecule norepinephrine (NE) is an etiological factor in some types of cancer.
  • (ii) human studies of tricyclic antidepressant use and cancer rate;.
  • (iii) existence of pheochromocytoma, a cancer of the adrenal glands;.
  • (iv) cancer rate in families with individuals who have bipolar disorder;.
  • (v) hypertension and cancer risk;.
  • (vi) excessive body weight and cancer risk; and (vii) psychological stressors and cancer risk.
  • Three aspects of the body's NE system are consistent with it playing an etiological role in various types of cancer: (i) NE circulates in the blood and can thereby access organ systems throughout the body, in addition to direct peripheral release by the sympathetic nervous system and being released within the brain;.
  • Most importantly, use of existing pharmaceutical drugs that either lower the level of NE (such as clonidine) or block NE receptors may lower the probability of an individual developing cancer, and this hypothesis could be tested immediately by an epidemiologist through examination of existing medical records.
  • [MeSH-major] Neoplasms / chemically induced. Norepinephrine / adverse effects
  • [MeSH-minor] Animals. Anticarcinogenic Agents / pharmacology. Clonidine / adverse effects. Humans. Models, Biological. Pheochromocytoma / etiology. Pheochromocytoma / pathology. Rats. Receptors, Adrenergic / metabolism. Receptors, Adrenergic / physiology

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  • [Copyright] Copyright 2008 Wiley-Liss, Inc.
  • [CommentIn] Int J Cancer. 2011 Feb 1;128(3):737-8; author reply 739 [20333678.001]
  • (PMID = 19004004.001).
  • [ISSN] 1097-0215
  • [Journal-full-title] International journal of cancer
  • [ISO-abbreviation] Int. J. Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Anticarcinogenic Agents; 0 / Receptors, Adrenergic; MN3L5RMN02 / Clonidine; X4W3ENH1CV / Norepinephrine
  • [Number-of-references] 82
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14. Horstmann M, Merseburger AS, Stenzl A, Kuczyk M: [Systemic therapy of malignant adrenal tumors]. Urologe A; 2006 May;45(5):605-8
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  • [Title] [Systemic therapy of malignant adrenal tumors].
  • Systemic treatment of advanced-stage adrenal malignancies is most often only palliative.
  • Mitotane alone or in combination with other chemotherapeutic agents such as cisplatin, etoposide, and vincristine are established therapeutic concepts for the treatment of metastatic adrenal cancer.
  • New therapeutic options are tumor vaccination and treatment with antiangiogenic drugs.
  • Metaiodobenzylguanidine as a radiotherapeutic drug or chemotherapeutic combination therapies that include cyclophosphamide, vincristine, and dacarbazine are applied for systemic treatment of malignant pheochromocytomas.. However, the clinical efficacy of the latter regimen needs further evaluation.
  • [MeSH-major] Adrenal Gland Neoplasms / drug therapy. Antineoplastic Agents / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chemotherapy, Adjuvant / methods. Neoplasm Recurrence, Local / prevention & control. Palliative Care / methods. Terminal Care / methods

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  • (PMID = 16622644.001).
  • [ISSN] 0340-2592
  • [Journal-full-title] Der Urologe. Ausg. A
  • [ISO-abbreviation] Urologe A
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 31
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15. Knüttgen D, Wappler F: [Anaesthesia for patients with phaeochromocytoma - specifics, potential complications and drug strategies]. Anasthesiol Intensivmed Notfallmed Schmerzther; 2008 Jan;43(1):20-7; quiz 28
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  • [Title] [Anaesthesia for patients with phaeochromocytoma - specifics, potential complications and drug strategies].
  • In contrast, sodium nitroprusside is the substance of choice for intraoperative control of blood pressure. alpha-blocking agents may be used in phaeochromocytoma but only under sufficient alpha-blockade.
  • Removal of a malignant tumour of the adrenal gland may induce massive haemorrhage, and thus anaesthetic management has to be modified.
  • [MeSH-major] Adrenal Gland Neoplasms / surgery. Anesthesia / methods. Arrhythmias, Cardiac / prevention & control. Hypertension / prevention & control. Nitroprusside / administration & dosage. Phenoxybenzamine / administration & dosage. Pheochromocytoma / surgery. Postoperative Complications / prevention & control
  • [MeSH-minor] Antihypertensive Agents / administration & dosage. Humans


16. Zografos GN, Vasiliadis G, Farfaras AN, Aggeli C, Digalakis M: Laparoscopic surgery for malignant adrenal tumors. JSLS; 2009 Apr-Jun;13(2):196-202
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  • [Title] Laparoscopic surgery for malignant adrenal tumors.
  • Advances in imaging have improved early detection of primary and metastatic adrenal tumors.
  • The laparoscopic approach, the gold standard for benign adrenal diseases, is controversial for malignant adrenal tumors.
  • A prospective randomized study of the role of laparoscopic surgery in adrenal cancer is not feasible because of the rarity of the disease.
  • A review of the literature demonstrates the safety and efficacy of laparoscopic adrenalectomy for solitary adrenal tumors.
  • In primary adrenal malignancies, the laparoscopic approach should be considered cautiously, only when it can achieve complete tumor resection with an intact adrenal capsule.
  • Conversion to an open procedure should be an early decision, prior to tumor morcellation or fracture of the tumor capsule.

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  • (PMID = 19660215.001).
  • [ISSN] 1086-8089
  • [Journal-full-title] JSLS : Journal of the Society of Laparoendoscopic Surgeons
  • [ISO-abbreviation] JSLS
  • [Language] ENG
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
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  • [Other-IDs] NLM/ PMC3015945
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17. Fitzgerald PJ: Is elevated norepinephrine an etiological factor in some cases of epilepsy? Seizure; 2010 Jul;19(6):311-8
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  • This paper examines the hypothesis that this neurotransmitter has proconvulsant properties, where much of the pharmaceutical evidence comes from rodent models.
  • (2) clonidine and other alpha 2 adrenergic agonist drugs that lower the level of NE;.
  • (3) prazosin and other drugs that affect alpha adrenoceptors;.
  • (4) propranolol and other drugs that affect beta adrenoceptors;.
  • (5) pheochromocytoma, which is a rare cancer of the adrenal glands that can boost NE levels;.
  • (6) comorbidity of epilepsy with bipolar disorder, hypertension, and obesity, where all four conditions may involve elevated NE; and (7) psychological stress, which is associated with increased release of NE.
  • [MeSH-minor] Adrenal Gland Neoplasms / complications. Adrenal Gland Neoplasms / metabolism. Adrenergic Uptake Inhibitors / pharmacology. Adrenergic alpha-Agonists / pharmacology. Adrenergic alpha-Antagonists / pharmacology. Adrenergic beta-Antagonists / pharmacology. Animals. Antidepressive Agents, Second-Generation / pharmacology. Bipolar Disorder / complications. Humans. Hypertension / complications. Pheochromocytoma / complications. Pheochromocytoma / metabolism. Stress, Psychological / metabolism

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  • [Copyright] 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
  • (PMID = 20493725.001).
  • [ISSN] 1532-2688
  • [Journal-full-title] Seizure
  • [ISO-abbreviation] Seizure
  • [Language] eng
  • [Grant] United States / Intramural NIH HHS / /
  • [Publication-type] Journal Article; Research Support, N.I.H., Intramural; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Adrenergic Uptake Inhibitors; 0 / Adrenergic alpha-Agonists; 0 / Adrenergic alpha-Antagonists; 0 / Adrenergic beta-Antagonists; 0 / Antidepressive Agents, Second-Generation; X4W3ENH1CV / Norepinephrine
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18. Lawnicka H, Kowalewicz-Kulbat M, Sicinska P, Altmann KH, Hofmann T, Stepien H: Resorcylic acid lactone L-783,277 inhibits the growth of the human adrenal cancer cell line H295R in vitro. Int J Immunopathol Pharmacol; 2009 Oct-Dec;22(4):889-95
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  • [Title] Resorcylic acid lactone L-783,277 inhibits the growth of the human adrenal cancer cell line H295R in vitro.
  • The resorcylic acid lactone L-783,277, isolated from a Phoma sp. (ATCC 74403), is a potent and specific inhibitor of MEK (Map kinase kinase) that exerts very interesting pharmacological activities including anti-neoplastic properties.
  • However, the role of this compound in the regulation of endocrine-related cancer cell growth and tumor progression remains unknown.
  • In the present study we have evaluated the effect of L-783,277 on the viability, proliferation and cell cycle of the human adrenocortical carcinoma cell line H295R.
  • At concentrations of 10(-6)-10(-8)M this effect was associated with the accumulation of H295R cells in S-phase, whereas at concentrations of 10(-9)-10(-10)M a prolonged G1-phase and reduced transition into S-phase were observed.
  • Our findings demonstrate for the first time the anti-proliferative action of L-783,277 on the human adrenocortical H295R cell line.
  • [MeSH-major] Adrenal Cortex Neoplasms / pathology. Adrenocortical Carcinoma / pathology. Antineoplastic Agents / pharmacology. Cell Proliferation / drug effects. Lactones / pharmacology. Mitogen-Activated Protein Kinase Kinases / antagonists & inhibitors. Protein Kinase Inhibitors / pharmacology. Resorcinols / pharmacology
  • [MeSH-minor] Apoptosis / drug effects. Cell Cycle / drug effects. Cell Line, Tumor. Cell Survival / drug effects. Dose-Response Relationship, Drug. Humans. Inhibitory Concentration 50

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  • (PMID = 20074452.001).
  • [ISSN] 0394-6320
  • [Journal-full-title] International journal of immunopathology and pharmacology
  • [ISO-abbreviation] Int J Immunopathol Pharmacol
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / L 783277; 0 / Lactones; 0 / Protein Kinase Inhibitors; 0 / Resorcinols; EC 2.7.12.2 / Mitogen-Activated Protein Kinase Kinases
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19. Tanaka K, Kumano Y, Kanomata N, Takeda M, Hara I, Fujisawa M, Kawabata G, Kamidono S: Oncocytic adrenocortical carcinoma. Urology; 2004 Aug;64(2):376-7
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  • Computed tomography demonstrated a massive tumor in the right abdomen.
  • Because renal or adrenal cancer was suspected, right adrenalectomy and nephrectomy were performed.
  • At last follow-up, the patient was alive with pulmonary and adrenal metastases and undergoing treatment with mitotane.
  • [MeSH-major] Adenocarcinoma / secondary. Adrenal Cortex Neoplasms / pathology
  • [MeSH-minor] Adrenalectomy. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bone Neoplasms / radiotherapy. Bone Neoplasms / secondary. Bone Neoplasms / surgery. Cisplatin / administration & dosage. Combined Modality Therapy. Doxorubicin / administration & dosage. Embolization, Therapeutic. Etoposide / administration & dosage. Humans. Liver Neoplasms / secondary. Liver Neoplasms / therapy. Lung Neoplasms / drug therapy. Lung Neoplasms / secondary. Lung Neoplasms / surgery. Magnetic Resonance Imaging. Male. Middle Aged. Mitotane / therapeutic use. Nephrectomy. Ribs / surgery. Tomography, X-Ray Computed

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  • (PMID = 15302503.001).
  • [ISSN] 1527-9995
  • [Journal-full-title] Urology
  • [ISO-abbreviation] Urology
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; 78E4J5IB5J / Mitotane; 80168379AG / Doxorubicin; Q20Q21Q62J / Cisplatin
  • [Number-of-references] 7
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20. Simi L, Malentacchi F, Luciani P, Gelmini S, Deledda C, Arvia R, Mannelli M, Peri A, Orlando C: Seladin-1 expression is regulated by promoter methylation in adrenal cancer. BMC Cancer; 2010;10:201
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  • [Title] Seladin-1 expression is regulated by promoter methylation in adrenal cancer.
  • Adrenal glands show the highest levels of seladin-1 expression, which are significantly reduced in adrenal carcinomas (ACC).
  • We treated DNA extracted from two ACC cell lines (H295R and SW13) with the demethylating agent 5-Aza-2-deoxycytidine (5-Aza).
  • Furthermore, to evaluate the presence of an epigenetic regulation also 'in vivo', seladin-1 methylation and its mRNA expression were measured in 9 ACC and in 5 normal adrenal glands.
  • In ACC, methylation density of seladin-1 promoter was higher (2682 +/- 686) than in normal adrenal glands (362 +/- 97; p = 0.02).
  • Seladin-1 mRNA expression in ACC (1452 +/- 196) was significantly lower than in normal adrenal glands (3614 +/- 949; p = 0.01).
  • [MeSH-major] Adrenal Gland Neoplasms / genetics. Carcinoma / genetics. DNA Methylation. Epigenesis, Genetic. Nerve Tissue Proteins / genetics. Oxidoreductases Acting on CH-CH Group Donors / genetics. Promoter Regions, Genetic
  • [MeSH-minor] Azacitidine / analogs & derivatives. Azacitidine / pharmacology. Cell Line, Tumor. DNA Modification Methylases / antagonists & inhibitors. DNA Modification Methylases / metabolism. Enzyme Inhibitors / pharmacology. Gene Expression Regulation, Enzymologic. Gene Expression Regulation, Neoplastic. Humans. Polymerase Chain Reaction. RNA, Messenger / metabolism. Time Factors

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  • (PMID = 20465827.001).
  • [ISSN] 1471-2407
  • [Journal-full-title] BMC cancer
  • [ISO-abbreviation] BMC Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Enzyme Inhibitors; 0 / Nerve Tissue Proteins; 0 / RNA, Messenger; 776B62CQ27 / decitabine; EC 1.3.- / Oxidoreductases Acting on CH-CH Group Donors; EC 1.3.1.- / DHCR24 protein, human; EC 2.1.1.- / DNA Modification Methylases; M801H13NRU / Azacitidine
  • [Other-IDs] NLM/ PMC2875219
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21. Bastida CM, Tejada F, Cremades A, Peñafiel R: Aminoglutethimide, a steroidogenesis inhibitor, abolishes hormonal induction of ornithine decarboxylase in steroidogenic tissues: evidence for its role as cAMP-dependent protein kinase inhibitor. Biochem Biophys Res Commun; 2001 Feb 16;281(1):244-8
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  • Aminoglutethimide (AMG), a potent inhibitor of steroidogenesis used in the treatment of breast cancer and some adrenal pathologies, abolished the induction of ornithine decarboxylase (ODC) elicited by peptide hormones and by dibutyryl-cAMP in steroidogenic tissues.
  • Taking into account that ODC, the rate-limiting enzyme in polyamine synthesis, is elevated in many types of cancer and that overexpression of this enzyme is associated with cell transformation, one may speculate that the inhibitory action of AMG on protein kinase A represents a positive colateral effect of this drug in cancer therapy.
  • [MeSH-minor] Adrenal Glands / drug effects. Adrenocorticotropic Hormone / pharmacology. Animals. Aromatase / metabolism. Chorionic Gonadotropin / blood. Chorionic Gonadotropin / metabolism. Chorionic Gonadotropin / pharmacology. Cytochrome P-450 Enzyme System / metabolism. Dose-Response Relationship, Drug. Enzyme-Linked Immunosorbent Assay. Female. Gonads / drug effects. Humans. Inhibitory Concentration 50. Ketoconazole / pharmacology. Male. Mice. Ovary / metabolism. Polyamines / metabolism. Testis / metabolism

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  • (PMID = 11178987.001).
  • [ISSN] 0006-291X
  • [Journal-full-title] Biochemical and biophysical research communications
  • [ISO-abbreviation] Biochem. Biophys. Res. Commun.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin; 0 / Enzyme Inhibitors; 0 / Polyamines; 0O54ZQ14I9 / Aminoglutethimide; 9002-60-2 / Adrenocorticotropic Hormone; 9035-51-2 / Cytochrome P-450 Enzyme System; EC 1.14.14.1 / Aromatase; EC 2.7.11.11 / Cyclic AMP-Dependent Protein Kinases; EC 4.1.1.17 / Ornithine Decarboxylase; R9400W927I / Ketoconazole
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22. Knüttgen D, Wappler F: [Anaesthesia for patients with adrenal gland diseases]. Anasthesiol Intensivmed Notfallmed Schmerzther; 2007 Mar;42(3):170-8
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  • [Title] [Anaesthesia for patients with adrenal gland diseases].
  • [Transliterated title] Anästhesie bei Erkrankungen der Nebennierenrinde--Effizientes Risikomanagement von der Prämedikation bis zum Aufwachraum.
  • Perioperative management of patients with adrenal gland diseases requires detailed information on the individual endocrine status and the potential complications.
  • Addison's disease, after removal of a cortisol producing tumour or as the result of long-term therapy with glucocorticoids) consequent perioperative supplementation of hydrocortisone is mandatory.
  • In contrast, nitroprusside is the substance of choice for intraoperative control of blood pressure. beta-blocking agents may be used in phaeochromocytoma but only under sufficient beta-blockade.
  • Removal of a malignant tumour of the adrenal gland may induce massive haemorrhage, and thus anaesthetic management has to be modified.
  • [MeSH-major] Adrenal Gland Diseases / complications. Adrenal Gland Diseases / surgery. Intraoperative Complications / prevention & control

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  • (PMID = 17366436.001).
  • [ISSN] 1439-1074
  • [Journal-full-title] Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
  • [ISO-abbreviation] Anasthesiol Intensivmed Notfallmed Schmerzther
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Androgens; 0 / Estrogens; 0 / Glucocorticoids; 0 / Mineralocorticoids
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23. Montoya M, Brown JW, Fishman LM: Comparative effects of chemotherapeutic agents on the growth and survival of human adrenal carcinoma cells in culture. Horm Metab Res; 2008 May;40(5):302-5
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  • [Title] Comparative effects of chemotherapeutic agents on the growth and survival of human adrenal carcinoma cells in culture.
  • Adrenocortical carcinoma is an uncommon malignancy that is usually fatal within a short time after diagnosis.
  • We have investigated the effects on the growth and survival of SW-13 human adrenal carcinoma cells in culture of some currently used and some potentially new agents in the treatment of adrenal cancer.
  • Established drugs tested were mitotane, cisplatin, etoposide, 5-fluorouracil, and suramin.
  • Other agents studied included adenine arabinofuranoside, cytosine arabinofuranoside, 2-methoxyestradiol, and paclitaxel.
  • The most potent chemotherapeutic agents in this system were paclitaxel and 2-methoxyestradiol, with EC (50) of 1.8x10 (-8) and 3.3x10 (-7) M, respectively.
  • All the other agents tested required much higher doses for effect, including mitotane, the current most commonly used chemotherapy for adrenal cancer, with an EC (50) of 3.3x10 (-4) M.
  • These data suggest that paclitaxel, 2-methoxyestradiol, and cytosine arabinofuranoside should be further evaluated for their potential in the chemotherapy of adrenal carcinoma.
  • [MeSH-major] Adrenal Gland Neoplasms / drug therapy. Antineoplastic Agents / pharmacology
  • [MeSH-minor] Cell Line, Tumor. Cell Survival / drug effects. Dose-Response Relationship, Drug. Drug Screening Assays, Antitumor / methods. Humans

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  • (PMID = 18491247.001).
  • [ISSN] 0018-5043
  • [Journal-full-title] Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et métabolisme
  • [ISO-abbreviation] Horm. Metab. Res.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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24. Cerquetti L, Bucci B, Marchese R, Misiti S, De Paula U, Miceli R, Muleti A, Amendola D, Piergrossi P, Brunetti E, Toscano V, Stigliano A: Mitotane increases the radiotherapy inhibitory effect and induces G2-arrest in combined treatment on both H295R and SW13 adrenocortical cell lines. Endocr Relat Cancer; 2008 Jun;15(2):623-34
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  • Mitotane, 1,1-dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl)ethane (o,p'-DDD) is an agent with adrenotoxic effect, which is able to block cortisol synthesis.
  • This drug and radiotherapy are used also in adrenal cancer treatment even if their biological action in this neoplasia remains unknown.
  • We investigated the effects of o,p'-DDD and ionizing radiations (IR) on cell growth inhibition and cell cycle perturbation in H295R and SW13 adrenocortical cancer cells.
  • This combination treatment induced an irreversible inhibition of cell growth in both adrenocortical cancer cells.
  • In these cells, cyclin B1 and Cdk2 proteins were examined by western blot and Cdk2 kinase activity measured by assay kit.
  • The same irreversible block on G2 phase, induced by IR/o,p'-DDD treatment, happened in H295R cells with restored wild-type p53 suggesting that this mechanism is not mediated by p53 pathway.
  • [MeSH-major] Adrenal Cortex Neoplasms / pathology. Adrenocortical Carcinoma / pathology. Antineoplastic Agents, Hormonal / pharmacology. Mitotane / pharmacology. Radiotherapy
  • [MeSH-minor] CDC2 Protein Kinase / metabolism. Cell Division / drug effects. Cell Division / radiation effects. Cell Line, Tumor. Cyclin B / metabolism. Cyclin B1. G2 Phase / drug effects. G2 Phase / radiation effects. Humans. RNA, Messenger / metabolism. Steroids / pharmacology. Tumor Suppressor Protein p53 / genetics

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  • (PMID = 18509009.001).
  • [ISSN] 1351-0088
  • [Journal-full-title] Endocrine-related cancer
  • [ISO-abbreviation] Endocr. Relat. Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / CCNB1 protein, human; 0 / Cyclin B; 0 / Cyclin B1; 0 / RNA, Messenger; 0 / Steroids; 0 / Tumor Suppressor Protein p53; 78E4J5IB5J / Mitotane; EC 2.7.11.22 / CDC2 Protein Kinase
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