title: Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression.
abstract: BACKGROUND
  Despite the widespread use of megestrol acetate (MA) among a growing number of pediatric oncology departments, there is only one published study on the use of MA in children with malignant disease. The objectives of the current study were to examine the effect of MA in improving the nutritional status of children with malignant disease and to describe and consider the implications of MA-associated adrenal suppression that was found consistently.
  
  
  METHODS
  Medical records of 19 children with malignant disease who were treated with MA were reviewed. During MA therapy, clinical assessments every 4 weeks included anthropometrics, caloric intake, quality-of-life scores, and appetite scores. Serum cortisol levels, lipid profiles (including cholesterol levels) random blood glucose levels, and coagulation screening were measured at 4-6-week intervals.
  
  
  RESULTS
  MA use was associated with significant increases in weight, weight z score, middle-upper arm circumference, triceps skin-fold thickness, appetite, and caloric intake. MA was extremely useful in aiding the efficient tapering of nasogastric feeds. However, a significant and potentially dangerous decrease in cortisol was seen in 10 of 11 patients tested, with 1 patient who manifested clinical hypoadrenalism with hemodynamic collapse, requiring inotropic support. This is the first report of MA-associated clinical adrenal suppression in a child with malignant disease.
  
  
  CONCLUSIONS
  Although the results of this study support the ability of MA to improve nutritional status, its use was complicated by severe adrenal suppression in almost all patients tested, with a serious clinical adverse event occurring in one patient. Routine hydrocortisone supplementation throughout MA treatment should be considered as well as larger doses for patients with acute illness and patients who undergo surgery.
authors.affiliation: Department of Clinical Hematology and Oncology, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Orme
authors.forename: Jodie D
authors.initials: JD
authors.lastname: Bond
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Humphrey
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Zacharin
authors.forename: Peter A
authors.initials: PA
authors.lastname: Downie
authors.forename: Kris M
authors.initials: KM
authors.lastname: Jamsen
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Robinson
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Grapsas
authors.forename: David M
authors.initials: DM
authors.lastname: Ashley
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology; D002528:Cerebellar Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000150:complications; D008297:Male; D008527:Medulloblastoma / Q000150:complications; D019290:Megestrol Acetate / Q000009:adverse effects* / Q000627:therapeutic use; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000150:complications
chemical_list: D019290:Megestrol Acetate