and no specific intervention is required. However, women with rare genetic abnormalities that affect triglyceride metabolism may develop gestational hypertriglyceridaemia which can be severe and associated with acute complications including
Albert S Kim, Rashida Hakeem, Azaliya Abdullah, Amanda J Hooper, Michel C Tchan, Thushari I Alahakoon, and Christian M Girgis
Angelo Paci, Ségolène Hescot, Atmane Seck, Christel Jublanc, Lionel Mercier, Delphine Vezzosi, Delphine Drui, Marcus Quinkler, Martin Fassnacht, Eric Bruckert, Marc Lombès, Sophie Leboulleux, Sophie Broutin, and Eric Baudin
Mitotane (o,p′-DDD) is the standard treatment for advanced adrenocortical carcinoma (ACC). Monitoring of plasma mitotane levels is recommended to look for a therapeutic window between 14 and 20mg/L, but its positive predictive value requires optimization. We report the case of an ACC patient with a history of dyslipidemia treated with mitotane in whom several plasma mitotane levels >30mg/L were found together with an excellent neurological tolerance. This observation led us to compare theoretical or measured o,p′-DDD and o,p′-DDE levels in a series of normolipidemic and dyslipidemic plasma samples to explore potential analytical issues responsible for an overestimation of plasma mitotane levels. We demonstrate an overestimation of mitotane measurements in dyslipidemic patients. Mitotane and o,p′-DDE measurements showed a mean 20% overestimation in hypercholesterolemic and hypertriglyceridemic plasma, compared with normolipidemic plasma. The internal standard p,p′-DDE measurements showed a parallel decrease in hypercholesterolemic and hypertriglyceridemic plasma, suggesting a matrix effect. Finally, diluting plasma samples and/or using phospholipid removal cartridges allowed correcting such interference.
- Hypercholesterolemia (HCH) and hypertriglyceridemia (HTG) induce an overestimation of plasma mitotane measurements.
- We propose a routine monitoring of lipidemic status.
- We propose optimized methodology of measurement before interpreting high plasma mitotane levels.
Kirun Gunganah, Ashley Grossman, and Maralyn Druce
drugs, gallstones, corticosteroids, excess alcohol and hypertriglyceridaemia were excluded. However, she was noted to have an elevated calcium level, which was thought to be the cause of her pancreatitis. As her parathyroid hormone (PTH) level was
Aysenur Ozderya, Sule Temizkan, Kadriye Aydin Tezcan, Feyza Yener Ozturk, and Yuksel Altuntas
, mild lobular inflammation and mild periportal fibrosis. We thought the liver disease was part of the Madelung's disease and also a result of the patient's uncontrolled diabetes. He had a severe hypertriglyceridaemia, which is consistent with