Mitotane for 21-Hydroxylase Deficiency in an Infertile Man

Abstract

To the Editor: Men with classic 21-hydroxylase deficiency are at risk for infertility.1 The mechanisms are complex and involve three factors: gonadotropin inhibition due to the excessive secretion of progestin by the adrenal glands, obstruction of the rete testis, and destruction of the testes by testicular adrenal rest tumors.1 We took advantage of the antisecretory and antitumoral activities of mitotane, a drug that induces “chemical adrenalectomy,”2,3 in an attempt to restore the fertility of a man with both 21-hydroxylase deficiency and azoospermia. The 21-hydroxylase deficiency was suspected at birth because of salt wasting and was confirmed by elevated serum . . .