title: Induction of adrenal suppression by megestrol acetate in patients with AIDS.
abstract: OBJECTIVE
  To investigate the development of secondary adrenal suppression in a patient with the acquired immunodeficiency syndrome (AIDS) who was receiving megestrol acetate.
  
  
  METHODS
  Case report of one patient abruptly withdrawn from long-term therapy with megestrol acetate; prospective study of four patients with AIDS who were starting therapy with megestrol acetate for cachexia.
  
  
  METHODS
  Outpatient clinic of a university hospital.
  
  
  METHODS
  Study patients received megestrol acetate, 80 mg three times daily.
  
  
  METHODS
  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.
authors.affiliation: Division of Endocrinology and Metabolism A-44, Albany Medical College, NY 12208, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Leinung
authors.forename: R
authors.initials: R
authors.lastname: Liporace
authors.forename: C H
authors.initials: CH
authors.lastname: Miller
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000328:Adult; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008535:Megestrol / Q000009:adverse effects / Q000031:analogs & derivatives*; D019290:Megestrol Acetate; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D008535:Megestrol; D019290:Megestrol Acetate