Br J Ophthalmol 87:500-501 doi:10.1136/bjo.87.4.500-a
  • Letter

Pigmentary retinopathy, macular oedema, and abnormal ERG with mitotane treatment

  1. W T Ng,
  2. M G Toohey,
  3. L Mulhall,
  4. D A Mackey
  1. St Vincent's Hospital, Fitzroy, Victoria, The Ballarat Eye Clinic, Ballarat, Victoria, Ocular Diagnostic Clinic and CERA, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  1. Correspondence to: David Mackey; d.mackey{at}
  • Accepted 12 August 2002

Adrenocortical carcinoma is a rare tumour with a poor prognosis. Mitotane (o,p'-DDD), a chemotherapy drug that suppresses the adrenal cortex and modifies peripheral steroid metabolism has been reported to cause ocular side effects including visual blurring, diplopia, cataract, toxic retinopathy with retinal haemorrhage, oedema, and papilloedema. We present a 32 year old woman with reduced visual acuity, retinal pigmentation, macular oedema, and abnormal ERG after taking mitotane. While primary hypoadrenalism in Addison's disease has never been reported to cause any retinal problem, secondary hypoadrenalism in adrenoleucodystrophy is associated with pigmentary retinopathy and other ocular findings. We postulate that the retinal problems secondary to mitotane treatment may act via a similar mechanism.

Case report

A 30 year old woman had a left nephrectomy, adrenalectomy, and chemotherapy in September 1997 following diagnosis of an adrenal carcinoma. In 1999, she was found to have secondary tumours in her lungs and liver. She was commenced on intra-arterial cisplatin and oral mitotane of up to 4.5 g daily for 6–8 months, ceasing in December 1999 because of …