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Primary Culture of Rat Adrenocortical Cells and Assays of Steroidogenic Functions
Published on: March 12, 2019
Megestrol acetate-induced adrenal insufficiency
Paula González Villarroel1, Isaura Fernández Pérez, Concepción Páramo
1Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. Paula.gonzalez.villaroel@sergas.es
Summary
Megestrol acetate, used for cancer and AIDS, can suppress the pituitary-adrenal axis, potentially causing adrenal insufficiency. This case highlights the importance of recognizing its glucocorticoid-like effects for diagnosis.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Megestrol acetate is a synthetic progestin with a history of use in advanced cancer and AIDS-related anorexia.
- Prolonged use or high doses are associated with endocrine side effects, including Cushing's syndrome and diabetes.
- Its mechanism involves interaction with the glucocorticoid receptor, potentially affecting the hypothalamic-pituitary-adrenal (HPA) axis.
Observation:
- A 74-year-old woman with breast cancer, treated with megestrol acetate, developed adrenal insufficiency.
- The patient's cancer was refractory to prolonged hormonal therapy with megestrol acetate.
- The clinical presentation suggested sub-clinical adrenal insufficiency secondary to megestrol acetate's effects.
Findings:
- Megestrol acetate's glucocorticoid-like activity can lead to suppression of the pituitary-adrenal axis.
- This suppression can manifest as adrenal insufficiency, even in the absence of overt Cushingoid features.
- The case underscores the potential for megestrol acetate to induce HPA axis dysfunction.
Implications:
- Recognizing the glucocorticoid-like properties of megestrol acetate is crucial for diagnosing adrenal insufficiency.
- Monitoring for adrenal insufficiency should be considered in patients on long-term megestrol acetate therapy.
- This understanding aids in managing patients with cancer or other conditions requiring megestrol acetate treatment.
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