[Chemical adrenalectomy induced by aminoglutethimide in the treatment of breast cancer. A review].

The clinical profile of aminoglutethimide (AG), an amino derivative of the hypnotic agent glutethimide, is described. AG suppresses estrogen formation in postmenopausal women by its inhibitory effect on steroid synthesis in the adrenal glands as well as in the peripheral tissues. The results of treatment of 959 breast cancer patients by AG and glucocorticoids in several studies are reviewed. The treatment of these patients, who were not selected according to the hormonal receptor status in their tumors, resulted in about 30% objective responses. About 50% of the patients with estrogen receptor positive tumors responded with an objective regression. The favorable effect of medical adrenalectomy is comparable to that of hypophysectomy or surgical adrenalectomy; the advantage of medical adrenalectomy compared to ablative endocrine surgery is reversibility of the inhibitory effect on the production of adrenal hormones and estrogens after cessation of treatment. The AG-glucocorticoid regimen appears to exert a greater effect on skeletal metastases than tamoxifen. Patients who fail on tamoxifen and other endocrine regimens can still benefit from AG-glucocorticoid treatment. The value of medical adrenalectomy as adjuvant treatment is not yet known. At present, several agents with a selective effect on androgen-to-estrogen conversion in the peripheral tissues are under study. Their potential as inhibitors of the estrogen production in breast cancer patients is considerable.