Mitotane, or o,p'-DDD, is an antineoplastic medication used in the treatment of adrenocortical carcinoma

Adrenocortical carcinoma

Adrenocortical carcinoma, also adrenal cortical carcinoma and adrenal cortex cancer, is an aggressive cancer originating in the cortex of the adrenal gland. Adrenocortical carcinoma is a rare tumor, with incidence of 1-2 per million population annually...

. It is an isomer of DDD

Dichlorodiphenyldichloroethane

Dichlorodiphenyldichloroethane is an organochlorine insecticide that is slightly irritating to the skin. DDD is a metabolite of DDT. DDD is colorless and crystalline; it is closely related chemically and is similar in properties to DDT, but it is considered to be less toxic to animals than is DDT...

  and is a derivative of DDT

DDT

DDT is one of the most well-known synthetic insecticides. It is a chemical with a long, unique, and controversial history....

. Its main use is in those patients who have persistent disease despite surgical resection, those who are not surgical candidates, or those who have metastatic disease.

It has been produced by Bristol Myers Squibb SpA but it is marketed as an orphan drug

Orphan drug

An orphan drug is a pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease...

 due to the small number of patients in need of it. A 2007 study of 177 patients shows a significant increase in the recurrence-free interval after radical surgery followed by mitotane when compared to surgery alone.

Mitotane alters steroid peripheral metabolism, directly suppresses the adrenal cortex and alters cortisone metabolism leading to hypocortisolism. Side effects as reported by Schteinberg et al. include anorexia

Anorexia (symptom)

Anorexia is the decreased sensation of appetite...

 and nausea

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

 (88%), diarrhea

Diarrhea

Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

 (38%), vomiting

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

  (23%), decreased memory

Memory

In psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....

 and ability to concentrate (50%), rash

Rash

A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...

 (23%), gynecomastia

Gynecomastia

Gynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"...

 (50%), arthralgia

Arthralgia

Arthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication....

 (19%), and leukopenia

Leukopenia

Leukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection....

 (7%).

Its trade name is Lysodren.

Veterinary use

Mitotane is also used to treat pituitary-dependent Cushing's syndrome

Cushing's syndrome

Cushing's syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone or CRH...

 in canines

Dog

The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...

. The medication is used in the controlled destruction of adrenal tissue, leading to a decrease in cortisol production.