title: Association between megestrol acetate treatment and symptomatic adrenal insufficiency with hypogonadism in male patients with cancer.
abstract: Patients with advanced cancer may develop cachexia, which is often treated with megestrol acetate (MA). In addition to thromboembolic disease, MA may cause symptomatic suppression of the hypothalamic pituitary adrenal axis. In male patients with cancer, treatment with MA may also suppress the gonadal axis, resulting in symptomatic androgen deficiency. Three cases are presented to highlight the symptomatic burden of adrenal insufficiency and hypogonadism. Clinicians need an increased awareness of the complication of adrenal insufficiency secondary to MA treatment and a low threshold to test for adrenal and gonadal dysfunction in symptomatic male patients with advanced cancer.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. rdev@mdanderson.org
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.forename: Egidio
authors.initials: E
authors.lastname: Del Fabbro
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000728:Androgens / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000009:adverse effects; D002100:Cachexia / Q000139:chemically induced / Q000188:drug therapy; D003907:Dexamethasone / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007006:Hypogonadism / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D019290:Megestrol Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods; D013739:Testosterone / Q000008:administration & dosage
chemical_list: D000728:Androgens; D000970:Antineoplastic Agents; D005938:Glucocorticoids; D013739:Testosterone; D003907:Dexamethasone; D019290:Megestrol Acetate; D006854:Hydrocortisone