Megestrol acetate therapy and secondary adrenal suppression

Abstract

MA causes secondary adrenal suppression that is thought to be due to its effect at the hypothalamic level. The authors recommend a short course of steroid replacement for patients receiving MA at times of acute illness.

A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

“…Megestrol acetate has glucocorticoid activity, and high doses or a prolonged treatment period with megestrol acetate reduce plasma ACTH and cortisol secretion, leading to adrenal insufficiency secondary to prolonged suppression of the hypothalamic-pituitary-adrenal axis [24][25][26][27]. In both the pilot and this study, megestrol acetate treatment was significantly associated with adrenal suppression on antiemetic dexamethasone therapy.…”

Critical illness-related corticosteroid insufficiency in cancer patients

“…Critically ill cancer patients with sepsis likely represent a high-risk sub-group for CIRCI given such factors as frequent and repetitive use of systemic corticosteroids, potential malignant involvement of the adrenal gland(s), irradiation-induced insult to the HPA axis [17,18], and impaired cortisol synthesis with megestrol [19,20]. Available data on the incidence of CIRCI are limited by the exclusion of patients with known [9] or advanced cancer [4] and the lack of information regarding enrollment of cancer patients [2, 3, 5-8, 10-12, 14].…”

A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

“…MA, a synthetic orally active progesterone derivative is being used increasingly and successfully to treat anorexia and cachexia in patients with a wide range of advanced malignancies [20][21][22]. However, MA has glucocorticoid activity and can induce significant adrenal suppression at the hypothalamicpituitary level [23][24][25][26]. In cancer patients co-treated with dexamethasone and MA, the incidence of adrenal suppression was remarkable-more than half of patients were affected in our presented study.…”