Endocrine Abstracts

The adrenolytic agent mitotane [o,p’-DDD or 1,1-(o,p’-dichlorodiphenyl)-2,2-dichloroethane] is a derivative of the insecticide DDT and is used for the treatment of adrenal carcinoma. It induces necrosis and atrophy of the adrenal cortex. Estrogenic action after single exposure but intense antiestrogenic action after repeated exposure of porcine ovarian follicles has been observed in vitro (Wojtowicz et al. 2004).

The aim of the study was to describe the case of a patient with a personality disorder in whom the loss and resumtion of ovarian function was observed after use and discontinuation of the drug mitotane.

A female patient, aged 43 years with a personality disorder, was obese. She decided that Cushing’s syndrome might have been the cause of the obesity and took the drug mitotane. A year after treatment the patient developed amenorrhea. FSH and LH levels were 40 and 25 IU/l, respectively, suggestive of the presence of menopause. The patient developed adrenal crisis 1.5 year after the administration of mitotane and was treated with hydrocortisone successfully. Blood cortisol levels were 0.1 μ/g/dl (normal values 5–25 μg/dl) and ACTH was 1000 pg/ml (normal values 9–52 pg/ml). The diagnosis of adrenal insufficiency was made and hydrocortisone 30 mg daily was administered. Mitotane was discontinued. A year after the discontinuation of mitotane FSH was 2 IU/l, LH 3.4 IU/l and estradiol 250 pg/ml. Menses resumed and the patient has regular menstrual function thereafter suggestive of normal ovarian function. It was not possible to discontinue hydrocortisone.

The extremely rare case of a patient with a personality disorder who took the drug mitotane and experienced adrenal and ovarian insufficiency is described. Discontinuation of mitotane resulted in the resumption of ovarian but not of adrenal function.