Charles L. Loprinzi, MD; Rafael Fonseca, MD; Michael D. Jensen, MD
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Loprinzi C., Fonseca R., Jensen M.; Induction of Adrenal Suppression by Megestrol Acetate. Ann Intern Med. 1996;124:613. doi: 10.7326/0003-4819-124-6-199603150-00016
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Published: Ann Intern Med. 1996;124(6):613.
TO THE EDITOR:
Leinung and colleagues  provided the first convincing report of a patient who became Addisonian after abrupt discontinuation of therapy with megestrol acetate. It has been well established that patients receiving megestrol acetate have markedly suppressed serum cortisol levels and decreased adrenocorticotropic hormone levels, consistent with a central suppression of the pituitary-adrenal axis . This suppression of the pituitary-adrenal axis appears to be asymptomatic in most patients receiving megestrol acetate. Patients generally do not become Cushingoid while receiving megestrol acetate, and previous episodes of Addisonian crises with abrupt discontinuation of megestrol acetate therapy have not been reported (despite the widespread use of megestrol acetate for decades). Nonetheless, recent experience from a randomized clinical trial  suggests that patients receiving megestrol acetate might have inadequate adrenal function during episodes of infection and, thus, an increased likelihood of septic deaths. This clinical trial involved patients with late-stage small-cell lung cancer who received a combination of cisplatin and etoposide. Patients were randomly assigned to receive either megestrol acetate (800 mg/d) or placebo. Despite less severe myelosuppression in the megestrol acetate arm, a tendency toward more septic deaths was noted in the patients receiving megestrol acetate (11 of 122 patients compared with 5 of 121 patients; P = 0.12).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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