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Induction of Adrenal Suppression by Megestrol Acetate in Patients With AIDS

Induction of Adrenal Suppression by Megestrol Acetate in Patients With AIDS

M C Leinung, R Liporace, C H Miller

Ann Intern Med. 1995 Jun 1;122(11):843-5.

PMID: 7741369

Abstract:

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Case report of one patient abruptly withdrawn from long-term therapy with megestrol acetate; prospective study of four patients with AIDS who were starting therapy with megestrol acetate for cachexia.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 micrograms/dL to 1.5 +/- 0.9 micrograms/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.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
ALP16960160	Cosyntropin acetate		16960-16-0 (free base)	Price

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