Megestrol acetate (MA) is a progestational agent that has been used in the management of AIDS cachexia and several types of hormone-dependent cancers. An increasing number of reports have suggested that the drug also has corticosteroid effects. Specifically, adrenal suppression, impairment of glucose tolerance, and Cushing's syndrome have been observed. The severity of symptoms appears to correlate with integrated drug exposure (dose times; duration). These findings are supported by in vitro binding studies and prolonged dosing studies in cats as well as by similar clinical findings with the related compound, medroxyprogesterone acetate. Because the clinical presentation may be insidious, and because patients receiving MA often are those with advanced disease, the iatrogenic association may not be recognized. Clinicians need to be aware of the potential for adrenal insufficiency in patients receiving or withdrawing from megestrol because these complications may be life-threatening.
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