Version June 2024
| Parameter | Interval | Comment |
| Mitotane blood level | Every 4 to 6 weeks¶ | Target: 14 to 20 mcg/mL (mg/L). |
| Adverse effects | At every visit (initially, every 4 weeks; after 6 months, every 8 weeks) | Gastrointestinal adverse effects: Use antiemetics (eg, metoclopramide or a 5-HT3 blocker) or loperamide. |
| ACTH | Suspected glucocorticoid deficiency or excess | CNS side effects (ataxia, confusion, speech or visual problems): Interrupt therapy or reduce dosage. Glucocorticoid status is difficult to determine. Target: ACTH in the normal range or slightly above. Because of an increased glucorticoid clearance, high-dose glucocorticoid replacement is needed (most patients require at least 50 mg hydrocortisone per day). |
| Serum sodium and potassium | At every visit | |
| 24-hour urine free cortisol | At every visit | Aim for mid-normal range. |
| GOT, GPT, bilirubin, GGT | Initially, every 4 weeks; after 6 months, every 8 weeks | GGT is invariably elevated without clinical consequences. If other liver enzymes are rapidly increasing (greater than threefold of baseline), there is risk of liver failure: Stop mitotane. |
| TSH, fT3, fT4 | Every 3 to 4 months | Disturbance of thyroid hormones is frequent. Thyroid hormone replacement is recommended in patients with clinical symptoms of hypothyroidism and low fT4 values. |
| Testosterone | Every 3 to 4 months | Hypogonadism frequently occurs. Replacement should be initiated in men with symptoms of hypogonadism. |
| Renin | Every 6 months | If renin is elevated, add fludrocortisone. |
| Cholesterol (HDL, LDL), triglycerides | Every 3 to 4 months (in an adjuvant setting) | If LDL or HDL cholesterol are highly elevated, consider treatment with statins. |
| Blood count | Every 3 to 4 months | Check for relevant leucopoenia, thrombocytopoenia, and anaemia (rare). |
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