CUSHINGS-SYNDROME AND HYPOTHALAMIC-PITUITARY-ADRENAL AXIS SUPPRESSIONINDUCED BY MEDROXYPROGESTERONE ACETATE

The referral of a patient with features of Gushing's syndrome but with suppressed plasma cortisol and adrenocorticotrophic hormone concentra tions prompted us to study the effect of medroxyprogesterone acetate ( MPA) therapy on the adrenal axis. 11 women (aged 54-82 years) who were receiving 200-400 mg/day MPA were studied, Of these, four had subnorm al plasma cortisol responses to a short synacthen test, and two more h ad borderline responses (30 min post-synacthen plasma cortisol results of 411 and 511 nmol/L). We conclude that suppression of the adrenal a xis occurs relatively frequently in patients on MPA and that such pati ents should be checked for evidence of suppression before MPA therapy is withdrawn.