Treatment of Mumps Orchitis with Adrenal Hormones

Abstract

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.

Mumps Epididymo-orchitis and its Treatment with Cortisone

“…Abnormality of liver-function tests was mentioned by Petersdorf and Bennett (1957), and some possible disturbance was found in 6 of our 11 patients in whom it was sought. These patients were selected only in so far as they were among the last 13 patients in our series.…”

“…The latter appeared related to some extent to the duration of the swelling in that no cases where that had lasted for less than three days from admission (or five days from onset) showed complete atrophy seven months later. Petersdorf and Bennett (1957) observed 23 sporadic cases over a four-year period in three different hospitals treated with three different corticosteroids in varying doses for varying lengths of time without any controls, and concluded that the hormones exerted a beneficial effect when compared with the previously described natural history of the illness. Their impression that patients who responded by crisis were less likely to show atrophic changes during the few months after acute disease and that the prompt administration of 300 mg. of cortisone or its equivalent was most important in achieving this result is not borne out by our study.…”

“…Smith and Bishir (1958), in a retrospective study of the notes of 95 patients, found that while cortisone reduced the duration of pain it did not affect the duration of swelling, fever, or stay in hospital, nor did it prevent the onset of orchitis. Petersdorf and Bennett (1957) found in 23 treated cases rapid defervescence and reduction of testicular swelling and fever, and regarded corticosteroids as the treatment of choice, though Risman (1956) found in five cases no effect on the course of ipsilateral orchitis but thought that contralateral orchitis, when it occurred, was less severe. In a series of 105 cases treated in Finnish military hospitals Klemola and Somer (1956) found no statistically significant difference in the duration of fever and orchitic symptoms in the three groups, one having placebo injections, one A.C.T.H.…”