Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Leinung, M. C.    Miller, C. H.    Related Articles in PubMed    PubMed Citation    PubMed

BRIEF COMMUNICATION

Induction of Adrenal Suppression by Megestrol Acetate in Patients with AIDS

Matthew C. Leinung; Ralph Liporace; and Cynthia H. Miller

1 June 1995 | Volume 122 Issue 11 | Pages 843-845

Objective: To investigate the development of secondary adrenal suppression in a patient with the acquired immunodeficiency syndrome (AIDS) who was receiving megestrol acetate.

Design and Patients: Case report of one patient abruptly withdrawn from long-term therapy with megestrol acetate; prospective study of four patients with AIDS who were starting therapy with megestrol acetate for cachexia.

Setting: Outpatient clinic of a university hospital.

Interventions: Study patients received megestrol acetate, 80 mg three times daily.

Measurements: Study patients had cosyntropin-stimulation testing and oral glucose tolerance testing before and after starting therapy with megestrol acetate.

Results: The patient described in the case report developed symptoms of adrenal insufficiency after withdrawal of megestrol acetate after 4 years of treatment. His basal cortisol and adrenocorticotropic hormone (ACTH) levels were low. He showed an abnormally diminished response to a short cosyntropin-stimulation test but did respond to a 3-day cosyntropin-stimulation test. The morning cortisol levels of the study patients decreased significantly (from 11.0 ±1.8 µg/dL to 1.5 ±0.9 µg/dL; P < 0.01), and the ACTH levels of these patients decreased to below normal (from 16.6 ±5.5 pg/mL to 6.3 ±3.3 pg/mL; P = 0.02) during treatment with megestrol acetate. Cortisol levels after administration of cosyntropin decreased significantly (from 27.3 ±3.3 pg/mL to 9.3 ±6.3 pg/mL; P = 0.01) during treatment with megestrol acetate. The results of oral glucose tolerance testing in two patients were consistent with the development of insulin resistance, and daily insulin requirements increased 10-fold in a patient who had preexisting diabetes.

Conclusions: Prolonged administration of megestrol acetate can induce clinically significant secondary adrenal suppression, and abrupt withdrawal of megestrol acetate after prolonged administration can cause adrenal insufficiency.

Author and Article Information

From Albany Medical College, Albany, New York.
Requests for Reprints: Matthew C. Leinung, MD, Division of Endocrinology and Metabolism A-44, Albany Medical College, New Scotland Avenue, Albany, NY 12208.
Acknowledgments: The authors thank Dr. A. David Goodman for his review of the manuscript.
Grant Support: Cosyntropin (Cortrosyn) was provided by Organon, Inc., West Orange, New Jersey.

This article has been cited by other articles:

				K. Mulligan, R. Zackin, J. H. Von Roenn, M. A. Chesney, M. J. Egorin, F. R. Sattler, C. A. Benson, T. Liu, T. Umbleja, S. Shriver, et al. Testosterone Supplementation of Megestrol Therapy Does Not Enhance Lean Tissue Accrual in Men with Human Immunodeficiency Virus-Associated Weight Loss: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 563 - 570. [Abstract] [Full Text] [PDF]

				J. Mayo, J. Collazos, E. Martinez, and S. Ibarra Adrenal Function in the Human Immunodeficiency Virus-Infected Patient Arch Intern Med, May 27, 2002; 162(10): 1095 - 1098. [Abstract] [Full Text] [PDF]

				J. Weisberg, J. Wanger, J. Olson, B. Streit, C. Fogarty, T. Martin, and R. Casaburi Megestrol Acetate Stimulates Weight Gain and Ventilation in Underweight COPD Patients* Chest, April 1, 2002; 121(4): 1070 - 1078. [Abstract] [Full Text] [PDF]

				C. L. Loprinzi, J. W. Kugler, J. A. Sloan, J. A. Mailliard, J. E. Krook, M. B. Wilwerding, K. M. Rowland Jr, J. K. Camoriano, P. J. Novotny, and B. J. Christensen Randomized Comparison of Megestrol Acetate Versus Dexamethasone Versus Fluoxymesterone for the Treatment of Cancer Anorexia/Cachexia J. Clin. Oncol., October 1, 1999; 17(10): 3299 - 3306. [Abstract] [Full Text] [PDF]

				S.-S. Yeh and M. W Schuster Geriatric cachexia: the role of cytokines Am. J. Clinical Nutrition, August 1, 1999; 70(2): 183 - 197. [Abstract] [Full Text] [PDF]

				C. Corcoran and S. Grinspoon Treatments for Wasting in Patients with the Acquired Immunodeficiency Syndrome N. Engl. J. Med., June 3, 1999; 340(22): 1740 - 1750. [Full Text] [PDF]

				J. Abrams, J. Aisner, C. Cirrincione, D. A. Berry, H. B. Muss, M. R. Cooper, I. C. Henderson, L. Panasci, J. Kirshner, J. Ellerton, et al. Dose-Response Trial of Megestrol Acetate in Advanced Breast Cancer: Cancer and Leukemia Group B Phase III Study 8741 J. Clin. Oncol., January 1, 1999; 17(1): 64 - 64. [Abstract] [Full Text] [PDF]

				R. H. Clarick, W. A. Hanekom, R. Yogev, and E. G. Chadwick Megestrol Acetate Treatment of Growth Failure in Children Infected With Human Immunodeficiency Virus Pediatrics, March 1, 1997; 99(3): 354 - 357. [Abstract] [Full Text] [PDF]

				Megace May Cause Adrenal-Pituitary Suppression AIDS Clinical Care, August 1, 1995; 1995(801): 8 - 8. [Full Text]