Chemotherapy: mitotane in adrenal carcinoma: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Chemotherapy: mitotane in adrenal carcinoma

Sample item

A 40-year-old woman with Cushing syndrome has a large adrenal mass with local invasion and is diagnosed with adrenocortical carcinoma. Which drug, directly toxic to adrenocortical cells, is used and requires glucocorticoid replacement during treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Mitotane

Mitotane is an adrenolytic derivative of the insecticide DDD that destroys adrenocortical cells and inhibits steroid synthesis. Adrenal insufficiency is expected, so hydrocortisone replacement is given alongside it. Gastrointestinal upset and neurotoxicity are common.

Option by option

  • A. Octreotide

    Octreotide is a somatostatin analogue used for pituitary and neuroendocrine tumours.

  • B. Metyrapone

    Metyrapone blocks 11-beta-hydroxylase but is not directly cytotoxic to the adrenal cortex.

  • C. Spironolactone

    Spironolactone antagonises aldosterone receptors and is not used for adrenal carcinoma.

  • D. Mitotane (correct)

    Correct. Mitotane is adrenolytic and causes adrenal insufficiency needing replacement.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Mitotane. Mitotane is an adrenolytic derivative of the insecticide DDD that destroys adrenocortical cells and inhibits steroid synthesis.

Why is "Octreotide" not the answer?

Octreotide is a somatostatin analogue used for pituitary and neuroendocrine tumours.

Why is "Metyrapone" not the answer?

Metyrapone blocks 11-beta-hydroxylase but is not directly cytotoxic to the adrenal cortex.

Why is "Spironolactone" not the answer?

Spironolactone antagonises aldosterone receptors and is not used for adrenal carcinoma.

What concept does this question test?

It tests Chemotherapy: mitotane in adrenal carcinoma in Pharmacology. Adrenal insufficiency is expected, so hydrocortisone replacement is given alongside it. Gastrointestinal upset and neurotoxicity are common.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chemotherapy: mitotane in adrenal carcinoma?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.