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.
Medical and Research Services, Veterans Administration Hospital, Hines, Illinois 60141.
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Sparagana
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