Table 2.

Drugs Used to Manage Hormonal Symptoms in Adrenal Cortical Carcinoma

Drug	Initial Dose	Titration	Maximum Dose	Adverse Effects
Mitotane	1-2 g/d as single or divided dose	1-2 g/d every 1-2 weeks	6-10 g/d with target serum level of 10-14 mg/L	Nausea, vomiting, anorexia, diarrhea, ataxia, speech disturbance, confusion, skin rash, and hyperbilirubinemia
Ketoconazole	200 mg three or four times per day	400 mg/d every 1-2 days	3,600-6,400 mg/d	Nausea, vomiting, abdominal pain, fever, weakness, hypertension, hypothyroidism, gynecomastia, and hypertriglyceridemia
Metyrapone	0.5-1 g/d in two to four divided doses	0.5-1 g/d every few days	4-6 g/d	Hypertension, alopecia, hirsutism, acne, nausea, abdominal discomfort, headache, weakness, and leukopenia
Etomidate*	0.1-0.3 mg/h infusion or 0.2-0.6 mg/kg intravenous bolus	0.1-0.3 over a few hours	3 mg/h†	Hypotension, myoclonus, and sedation

^*Propylene glycol vehicle.

^†Daily dose of propylene glycol should not exceed 25 mg/kg.