Adrenocortical carcinoma historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

In 1893, Grawitz et al was the first one who described adrenocortical carcinoma (ACC), and falsely assumed that it was hypernephroma. By 1938, the Mayo group had removed tumors successfully from 16 consecutive patients, most of whom had Cushing’s syndrome. In 1960, mitotane was first used clinically to treat inoperable or recurrent ACC.

• In 1811, an association of virilization and an adrenal tumor was first observed during an autopsy.
• In 1890, virilization was first documented following resection of an adrenal tumor.
• In 1893, Grawitz et al was the first one who described ACC and falsely assumed it was a hypernephroma.^[1]
• In 1934, Walters et al described Cushing’s syndrome in patients with adrenal tumors and emphasized that the characteristic findings were not exclusively related to the pituitary disease.^[2]
• In 1899, Knowsly Thornton of London was the first surgeon to successfully remove the adrenal cancer.
• From 1905 to 1929, a number of patients were described with what was termed the adrenogenital syndrome and others with adrenal tumors with virilism.
• By 1933, there was a clear evidence that the pituitary secretes an adrenocortical factor which was later recognized as ACTH.^[3]
• By 1938, the Mayo group had removed tumors successfully from 16 consecutive patients, most of whom had Cushing’s syndrome.
• In 1949, cortisol was discovered for the first time as a preparation.^[4]
• Between 1930 and 1949, nearly 300 patients with ACC were published.
• In 1949, the first patient with Cushing’s disease was treated with pre-operative cortisol.
• By 1955, Tait and Simpson in London and Reichstein in Basel had isolated and prepared aldosterone for clinical use as fludrocortisone.
• By 1957, an intravenous preparation of cortisol, hydrocortisone, was used for the first time intraoperatively and in urgent situations of adrenal insufficiency.^[5]
• In 1960, mitotane was first used clinically to treat inoperable or recurrent ACC.