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.

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A 71-year-old diabetic white male was admitted with weakness, weight loss, fever, gastrointestinal symptoms, and postural hypotension. At first he was treated with digitalis and diuretics for congestive heart failure. However, he became worse and increasing signs of adrenal insufficiency appeared although there was no hyperpigmentation. Urinary steroid values before and after administration of ACTH, and the responses to fluorohydrocortisone and cortisone acetate supported the diagnosis of Addison's disease. After initial improvement, myocardial infarction, vasomotor collapse and pneumonia intervened. Despite increased dosages of steroids and the administration of antibiotics, oxygen and vasopressors, the patient died. At necropsy, the adrenals were found to be completely replaced by reticulum-cell sarcoma. The tumor had invaded the upper pole of both kidneys, but no tumor tissue was found in the lymph nodes or in any other location. Presumably the tumor arose within the adrenals. --Adrenocortical insufficiency may result from anyone of a variety of factors causing adrenal destruction, e.g., bacterial infection, granuloma, fungus, amyloid, or tumor.Lymphoma can involve the adrenals but rarely causes adrenal insufficiency (1). However, such lymphomas usually are widespread and the adrenal involvement is merely part of the generalized disease.A search of the literature to date (via MEDLARS to 1963) failed to reveal any reports of lymphomas which arise within and are confined to the adrenalsoThe present report describes a case in which a reticulum-cell sarcoma apparently arose within the adrenals and completely destroyed them; no tumor tissue was found elsewhere except for some invasion into the superior poles of the kidneys.

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