The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Induction of Adrenal Suppression by Megestrol Acetate in Patients with AIDS

Matthew C. Leinung, MD; Ralph Liporace, MD; and Cynthia H. Miller, MD
[+] Article, Author, and Disclosure Information

From Albany Medical College, Albany, New York. Requests for Reprints: Matthew C. Leinung, MD, Division of Endocrinology and Metabolism A-44, Albany Medical College, New Scotland Avenue, Albany, NY 12208. Acknowledgments: The authors thank Dr. A. David Goodman for his review of the manuscript. Grant Support: Cosyntropin (Cortrosyn) was provided by Organon, Inc., West Orange, New Jersey.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(11):843-845. doi:10.7326/0003-4819-122-11-199506010-00006
Text Size: A A A

Objective: To investigate the development of secondary adrenal suppression in a patient with the acquired immunodeficiency syndrome (AIDS) who was receiving megestrol acetate.

Design and Patients: Case report of one patient abruptly withdrawn from long-term therapy with megestrol acetate; prospective study of four patients with AIDS who were starting therapy with megestrol acetate for cachexia.

Setting: Outpatient clinic of a university hospital.

Interventions: Study patients received megestrol acetate, 80 mg three times daily.

Measurements: Study patients had cosyntropin-stimulation testing and oral glucose tolerance testing before and after starting therapy with megestrol acetate.

Results: The patient described in the case report developed symptoms of adrenal insufficiency after withdrawal of megestrol acetate after 4 years of treatment. His basal cortisol and adrenocorticotropic hormone (ACTH) levels were low. He showed an abnormally diminished response to a short cosyntropin-stimulation test but did respond to a 3-day cosyntropin-stimulation test. The morning cortisol levels of the study patients decreased significantly (from 11.0 ±1.8 µg/dL to 1.5 ±0.9 µg/dL; P < 0.01), and the ACTH levels of these patients decreased to below normal (from 16.6 ±5.5 pg/mL to 6.3 ±3.3 pg/mL; P = 0.02) during treatment with megestrol acetate. Cortisol levels after administration of cosyntropin decreased significantly (from 27.3 ±3.3 pg/mL to 9.3 ±6.3 pg/mL; P = 0.01) during treatment with megestrol acetate. The results of oral glucose tolerance testing in two patients were consistent with the development of insulin resistance, and daily insulin requirements increased 10-fold in a patient who had preexisting diabetes.

Conclusions: Prolonged administration of megestrol acetate can induce clinically significant secondary adrenal suppression, and abrupt withdrawal of megestrol acetate after prolonged administration can cause adrenal insufficiency.


Grahic Jump Location
Figure 1.
Response of the pituitary-adrenal axis to megestrol acetate therapy in three patients. Top.Bottom.

Plasma adrenocorticotropic hormone (ACTH) values before and after 1 month of therapy with megestrol acetate. The dotted line represents the lower limit of the normal range (9 pg/mL). Response to a 1-hour cosyntropin-stimulation test at baseline and after 1 month of therapy with megestrol acetate. The normal response is an increase in plasma cortisol level to more than 20 µg/dL.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.