title: High prevalence of adrenal suppression during acute illness in hospitalized patients receiving megestrol acetate.
abstract: BACKGROUND
  Megestrol acetate (MA) is a progestational agent used for palliation of breast and endometrial cancer. The drug promotes weight gain via appetite stimulation. This property has led to widespread use in patients with wasting illnesses. Increasing numbers of reports suggest glucocorticoid activity.
  
  
  OBJECTIVE
  Unrecognized adrenal suppression may result from MA use. This is the first study to examine the prevalence of adrenal suppression in hospitalized patients treated with MA.
  
  
  METHODS
  This is a cross-sectional study of hospitalized patients receiving MA compared to control subjects. Morning cortisol levels, endocrine signs and symptoms, and duration of MA therapy were evaluated in 28 hospitalized medical patients treated with MA, and 21 control patients admitted to the same hospital service during the study period.
  
  
  RESULTS
  Median cortisol levels were significantly lower in patients using MA vs controls (160 vs 386 nmol/l, p=0.003). Forty-three percent of subjects on MA demonstrated morning cortisol levels below the normal range (138-690 nmol/l), compared with 10% of controls (p=0.013). Ninety-three percent of subjects taking MA had morning cortisol levels below the level that excludes adrenal insufficiency in hospitalized patients (497 nmol/l) vs 71% of controls (p=0.06).
  
  
  CONCLUSIONS
  MA use is associated with significant adrenal suppression in acutely ill individuals. This should alert physicians to the possibility of adrenal insufficiency and the need to assess for signs or symptoms of adrenal insufficiency, and mandates a low threshold for testing adrenal function in hospitalized patients taking MA.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Beth Israel Medical Center, 20 Baird Hall, 350 East 17th Street, New York, NY 10003, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Chidakel
authors.forename: S B
authors.initials: SB
authors.lastname: Zweig
authors.forename: J R
authors.initials: JR
authors.lastname: Schlosser
authors.forename: P
authors.initials: P
authors.lastname: Homel
authors.forename: J W
authors.initials: JW
authors.lastname: Schappert
authors.forename: A M
authors.initials: AM
authors.lastname: Fleckman
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000368:Aged; D000369:Aged, 80 and over; D019167:Appetite Stimulants / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D019290:Megestrol Acetate / Q000009:adverse effects*; D008875:Middle Aged; D019282:Wasting Syndrome / Q000188:drug therapy
chemical_list: D019167:Appetite Stimulants; D019290:Megestrol Acetate; D006854:Hydrocortisone