Megestrol-induced clinical adrenal insufficiency

Objective: To describe a case of megestrol-induced adrenal insufficiency.

Methods: A patient who received megestrol and then developed pituitary-adrenal axis abnormalities is described. The literature is reviewed.

Results: The patient developed megestrol-induced Cushingoid features. She developed adrenal insufficiency when megestrol was stopped.

Conclusion: Megestrol can induce alterations of the pituitary-adrenal axis in some patients. It is important to consider a diagnosis of adrenal insufficiency in patients with symptoms of fatigue, hypotension, and asthenia who have been treated with megestrol.

Megestrol; Adrenal insufficiency; Cushingoid Features

[1] Bonte J., Decoster J. M., Ide P., Billiet G.: "Hormonotherapy in the treatment of endometrial adenocarcinoma by means of medroxyprogesterone acetate". Gynecol. Oncol., 1978, 6, 60.

[2] Nathwani D., Green S. T., Heslop J. M.: "Beneficial response to megestrol acetate in AIDS-related cachexia and a possible megestrol withdrawal-associated syndrome". Acta Dermato-Venereologica, 1990, 70, 520.

[3] Subramanian S., Goker H., Kanji A., Sweeney H.: "Clinical adrenal insufficiency in patients receiving megestrol therapy". Arch. Intern. Med., 1997, 157, 1008.

[4] Mann M., Koller E., Murgo A., Malozowski S., Bacsanyi J., Leinung M. C.: "Glucocorticoid activity of mcgestrol". Arch. Inter. Med., 1997, 157, 1651.

[5] Nelson L., Rybo G.: "Treatment of menorrhagia". Am. J. Obstet. Gynecol., 1971, 110, 713.

[6] Zuckerman B., Lavie 0., Neuman M., Rabinowitz R., BenChetrit A., Voss E. et al.: "Endometrial carcinoma Stage I -grade II. Conservative treatment followed by a healthy twin pregnancy". Int. J. Gynecol. Cancer, 1998, 8, 172.

[7] Leinung M. C., Liporace R., Miller C. H.: "Induction of adrenal suppression by megestrol acetate in patients with AIDS". Ann. Intern. Med., 1995, 122, 843.

[8] Steer K. A., Kurtz A. B., Honour J. W.: "Mege、trol-induced Cushing's syndrome". Clin. Endocrinol., 1995, 42, 91.

[9] Poulin R., Baker D., Poirier D., Labrie F.: "Multiple actions of synthetic progestins on the growth of ZR-75-1 human breast cancer cells :an in vitro model for the simultaneous assay of androgen, progestin, oestrogen and glucocorticoid agonistic and antagonistic activities of steroids". Breast Cancer Res. Treat., 1991, 77, 197.

[10] Briggs M. H.,B riggs M.:" Glucocorticoid properties of progestins". Steroids, 1973, 22, 555.

[11] Loprinzi C. L.,J ensen M. D.,J iang H.,S chaid D. J.:" Effect of megestrol acetate on the human pituitary-adrenal axis" Mayo Clin. Proc., 1992, 67, 1160.