title: Megestrol acetate to correct the nutritional status in an adolescent with growth hormone deficiency: Increase of appetite and body weight but only by increase of body water and fat mass followed by profound cortisol and testosterone depletion.
abstract: Megestrol acetate (MA) is a synthetic, orally active derivative of the naturally occurring hormone progesterone. MA is increasingly used to correct loss of appetite and improve the nutritional status. We used MA in an adolescent with growth hormone (GH) deficiency due to former irradiation therapy in order to evaluate if MA can improve the nutritional status. In fact, MA increased appetite and weight dose-dependent. The energy expenditure measured by indirect calorimetry changed from hypo- to normometabolism. However, weight gain was first primarily due to an increase in body water and then in fat mass. The gain of fat mass was much more prominent than the gain of fat free mass. As important side-effect, MA lead to rapid and profound cortisol and testosterone depletion after only 10 days with a long-lasting effect on testosterone depletion. Therefore, MA as a single therapy cannot be recommended to improve the nutritional status. If MA is given, cortisol and testosterone levels have to be monitored and supplemented as needed.
authors.affiliation: Department of Paediatric Oncology, Kinderklinik and Kinderpoliklinik, Dr. von Haunersches Kinderspital, University of Munich, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Schmid
authors.forename: D K
authors.initials: DK
authors.lastname: Stachel
authors.forename: S
authors.initials: S
authors.lastname: Freudenberg
authors.forename: M
authors.initials: M
authors.lastname: Schmitt
authors.forename: F
authors.initials: F
authors.lastname: Schuster
authors.forename: R J
authors.initials: RJ
authors.lastname: Haas
mesh_terms: D000273:Adipose Tissue / Q000187:drug effects; D000293:Adolescent; D001066:Appetite / Q000187:drug effects*; D001823:Body Composition / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D002528:Cerebellar Neoplasms / Q000628:therapy; D004393:Dwarfism, Pituitary / Q000188:drug therapy* / Q000209:etiology; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency*; D008297:Male; D008527:Medulloblastoma / Q000628:therapy; D019290:Megestrol Acetate / Q000009:adverse effects* / Q000627:therapeutic use; D009752:Nutritional Status / Q000187:drug effects*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D013739:Testosterone / Q000172:deficiency*; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: D019382:Human Growth Hormone; D013739:Testosterone; D019290:Megestrol Acetate; D006854:Hydrocortisone