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Megestrol Acetate in the Spectrum of Adrenal Insufficiency
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
I read with interest Dr. Carey's editorial on the causes and clinical presentations of adrenal insufficiency [1]. An additional medication that should be mentioned as a cause of iatrogenic adrenal insufficiency is megestrol acetate. A recent literature search and review of U.S. Food and Drug Administration adverse-event reports have shown that megestrol acetate has glucocorticoid-like activity that can result in clinical presentations of the Cushing syndrome, diabetes mellitus, and adrenal insufficiency [2]. The past reports suggest that clinically significant adrenal insufficiency may occur after discontinuation of therapy with the medication, but evidence indicates that this condition may also occur during therapy [3]. The mechanism of action is thought to be due to the binding of megestrol acetate to the glucocorticoid receptor and suppression of the pituitary-adrenal axis [2].
Awareness of this association is important because of the expanding use of this medication. Megestrol acetate is commonly used to treat cancer of the breast and endometrium and anorexia-cachexia syndromes in patients with cancer and HIV infection [2]. Megestrol acetate may also be useful in the treatment of anorexia-cachexia in geriatric nursing home residents [4] and hot flashes in both men and women [5].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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