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Progestogens and Cushing's syndrome

C Harte¹, M T Henry, K D Murphy

¹Department of Medicine, Cork University Hospital, Wilton.

Irish Journal of Medical Science

|October 1, 1995

Summary

Medroxyprogesterone acetate (MPA) and Megestrol acetate, used for breast cancer, can cause Cushing's syndrome. Awareness and testing are crucial, especially in elderly women, to manage potential side effects and avoid withdrawal complications.

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Area of Science:

Endocrinology
Oncology
Pharmacology

Background:

Medroxyprogesterone acetate (MPA) and Megestrol acetate are commonly used progestogens in breast cancer therapy.
Adverse effects of MPA include weight gain, hypertension, and fluid retention, with potential for glucocorticoid-like effects.

Observation:

Three patients developed clinical hypercortisolism and Cushing's syndrome while receiving therapeutic doses of MPA or Megestrol acetate.
Cushing's syndrome was observed in patients taking as little as 400 mg/day of MPA.
Glucocorticoid-like effects and Cushing's syndrome were not previously reported with Megestrol acetate.

Findings:

Progestogen therapy, particularly MPA, can induce significant glucocorticoid-like effects and Cushing's syndrome in patients, including elderly females.
Suppression of the hypothalamic-pituitary-adrenal (HPA) axis by progestogens poses a risk of morbidity upon sudden withdrawal.
Signs of hypercortisolism may be subtle and easily overlooked without specific diagnostic testing for Cushing's syndrome.

Implications:

Healthcare providers must be vigilant for iatrogenic Cushing's syndrome in patients treated with MPA or Megestrol acetate.
Appropriate diagnostic evaluation for Cushing's syndrome is essential in patients exhibiting relevant symptoms.
Dose reduction of progestogens, when feasible, may mitigate morbidity while maintaining necessary therapeutic effects.

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