Progesterone for Outpatient Treatment of Pickwickian Syndrome

Abstract

Ten patients with the Pickwickian syndrome, characterized by obesity, hypoxemia, hypercapnia, polycythemia, and cor pulmonale, underwent long-term treatment as outpatients with medroxyprogesterone acetate. Although there was no significant weight change in the group, PaO2 rose 12.6 +/- 2.7 mm Hg (SEM) from 49 +/- 2.6 mm Hg to 62 +/- 2.3 mm Hg (P less than 0.001), while PaCO2 fell 13 +/- 2.6 mm Hg from 51 +/- 1.9 mm Hg to 38 +/- 1.2 mm Hg (P less than 0.001). Hematocrit fell from 56 +/- 2.5% to 50 +/- 1.2%, a mean fall of 6% (P less than 0.01), during medroxyprogesterone acetate therapy. In the 2 patients who had cardiac catheterization before and during medroxyprogesterone acetate therapy, mean pulmonary arterial pressure fell 13 and 19 mm Hg. There were no recurrences of cor pulmonale during treatment. These effects on arterial blood gas values and clinical state were sustained during therapy. On withdrawal of medroxyprogesterone acetate during 1-month period, arterial oxygen and carbon dioxide tensions deteriorated to their previous pretreatment values. Reinstitution of medroxyprogesterone acetate caused improvement in both the oxygen and carbon dioxide tensions. We conclude that sublingual medroxyprogesterone acetate therapy is useful in the management of the Pickwickian syndrome.

The Control of Breathing in Clinical Practice

“…99,100 The enhancement of central respiratory drive by drugs such as medroxyprogesterone is sometimes effective. 101 …”

“…119 Methylprogesterone can be used to stimulate ventilatory drive in patients with obesityhypoventilation syndrome. 101 Drugs such as the opioid antagonist naloxone and the benzodiazepine antagonist flumazenil may be used to counter the respiratory depressive effects of these drugs. They are particularly useful in the acute treatment of the overdose patient.…”

Progesterone reverses the neuronal responses to hypoxia in rat nucleus tractus solitarius in vitro

“…In addition to stimulating the ventilatory response to hypoxia, progesterone exerts a neuroprotective effect on neurones during adaptive and pathological processes such as cortical hypoxia and ischaemia (Jiang et al 1996). These stimulatory and neuroprotective properties may render progesterone useful as a treatment for patients suffering from chronic hypoxia (Sutton et al 1975;Lombard et al 1985;Stein, 2001). Brainstem chemosensitivity and neuroprotective properties of progesterone suggest that part of the stimulation by progesterone on the hypoxic ventilatory response may be due to a neuronal effect.…”

Obstructive Sleep Apnea: Part Ii. Treatment Modalities.

“…The data showing benefit of medroxyprogesterone in the treatment of obesity hypoventilation syndrome is limited by the small numbers of patients and the lack of long term results. [26][27][28][29][30][31] Hypothyroidism has been associated with sleep disordered breathing. 32 Nine out of eleven consecutive patients with hypothyroidism were reported to have OSA.…”