Epididymo-orchitis occurs as a complication in the course of mumps in 18% to 43% of postpubertal males.1-4 Not only is gonadal involvement accompanied by severe local pain and systemic discomfort, but testicular atrophy is a sequel in about one-half of the cases, and sterility can result, although this is probably unusual.5,6 Of the various prophylactic measures that have been tried in males with epidemic parotitis, the administration of diethylstilbestrol has given encouraging results,7,8 and early injection of \g=g\-globulinprepared from mumps convalescent serum has resulted in definite reduction in the incidence of orchitis.9 The treatment of established orchitis, however, has remained unsatisfactory. Antibiotics,10-14 pooled plasma,15-17 convalescent serum,18 estrogens,7 and surgical decompression [19][20][21] have been irregularly effective. At present, the usual regimen consists of analgesic and antipyretic drugs with local application of cold and the use of various suspensory devices.The few available descriptions of the his¬ tologie characteristics of mumps orchitis20 indicate that distention of seminiferous tubules by inflammatory exúdate, edema of intertubular connective tissue, swelling of the tunica albugínea, and acute hydrocele22 combine to produce pressure necrosis of the gonad. This supports the clinical impres-sion that swelling of the testicle within its unyielding tunics is the major factor respon¬ sible for acute pain and subsequent atrophie changes. This concept, of course, is the rationale for surgical decompression.The remarkable anti-inflammatory proper¬ ties of the adrenal steroids as well as their efficacy in alleviating a variety of "febrile toxemic" states suggested that these hor¬ mones might be useful in the management of mumps orchitis. The present report sum¬ marizes our experience with the use of cortisone and related compounds in the treat¬ ment of 23 cases of mumps orchitis during the past four years.
Clinical MaterialThe 23 patients with mumps orchitis that form the basis of this report were observed during a period of four years on the They ranged in age from 13 to 44 years. All cases were sporadic ; no true epi¬ demic occurred during the period of study. In none of the hospitals where the study was carried out is it customary to admit patients with uncom¬ plicated epidemic parotitis.Examinations of cerebrospinal fluid, liver func¬ tion tests, serum amylase determinations, and mumps complement-fixation tests were carried out in several, but not all, patients. The results of adrenal steroid therapy were noted and recorded carefully during the acute dis¬ ease. Later follow-up examinations were possible in only 14 cases. There was considerable variation in dosage of hormones in individual cases during the period of the study, depending upon several factors, including availability of drugs, expense, and response to treatment.The pertinent data for the 23 cases are sum¬ marized in Table 1.
