Primary hypogonadism associated with o,p' DDD (mitotane) therapy.
Mitotane is a drug which is concentrated largely in adipose tissue and the adrenal glands. It has a remarkable specificity for the adrenal cortex and can produce necrosis of that organ; consequently, it has been used as a therapeutic agent for adrenocortical carcinoma. Because of the similarity between adrenocortical and testicular tissue, mitotane could be expected to cause testicular damage; however, there is sparse support for this in the literature. We recently studied a patient who developed impotency due to primary testicular failure at the time that he was treated with mitotane. A testicular biopsy, performed about four months after the drug was discontinued, showed normal appearing Leydig cells and atrophy of the seminiferous tubules with the picture of a maturation arrest. In the four and one half years since he last received mitotane, the patient's libido has slowly improved and his plasma testosterone, gonadotropins and LH response to gonadotropin-releasing hormone have become essentially normal. We propose that mitotane can be cytotoxic to the testis as it is to the adrenal cortex.
Sparagana
M
M
Medical and Research Services, Veterans Administration Hospital, Hines, Illinois 60141.
D000182:ACTH Syndrome, Ectopic / Q000188:drug therapy; D000328:Adult; D007172:Erectile Dysfunction / Q000139:chemically induced; D006062:Gonadotropins / Q000097:blood; D006801:Humans; D007006:Hypogonadism / Q000139:chemically induced*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008939:Mitotane / Q000009:adverse effects*; D013737:Testis / Q000187:drug effects; D013739:Testosterone / Q000097:blood
D006062:Gonadotropins; D013739:Testosterone; D008939:Mitotane; D007986:Luteinizing Hormone