Mc. Leinung et al., INDUCTION OF ADRENAL SUPPRESSION BY MEGESTROL-ACETATE IN PATIENTS WITH AIDS, Annals of internal medicine, 122(11), 1995, pp. 843-845
Objective: To investigate the development of secondary adrenal suppres
sion in a patient with the acquired immunodeficiency syndrome (AIDS) w
ho was receiving megestrol acetate. Design and Patients: Case report o
f one patient abruptly withdrawn from long-term therapy with megestrol
acetate; prospective study of four patients with AIDS who were starti
ng therapy with megestrol acetate for cachexia. Setting: Outpatient cl
inic of a university hospital. Interventions: Study patients received
megestrol acetate, 80 mg three times daily. Measurements: Study patien
ts had cosyntropin-stimulation testing and oral glucose tolerance test
ing before and after starting therapy with megestrol acetate. Results:
The patient described in the case report developed symptoms of adrena
l 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 shor
t cosyntropin-stimulation test but did respond to a 3-day cosyntropin-
stimulation test. The morning cortisol levels of the study patients de
creased significantly (from 11.0 +/- 1.8 mu g/dL to 1.5 +/- 0.9 mu g/d
L; P < 0.01), and the ACTH revels of these patients decreased to below
normal (from 16.6 +/- 5.5 pg/mL to 6.3 +/- 3.3 pg/mL; P = 0.02) durin
g treatment with megestrol acetate. Cortisol levels after administrati
on 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 con
sistent with the development of insulin resistance, and daily insulin
requirements increased 10-fold in a patient who had preexisting diabet
es. Conclusions: Prolonged administration of megestrol acetate can ind
uce clinically significant secondary adrenal suppression, and abrupt w
ithdrawal of megestrol acetate after prolonged administration can caus
e adrenal insufficiency.