Megace (Megestrol Acetate) Induced Hypogonadism In A Male Patient - A Case Report [Abstract #902]
http://am.aace.com/files/Abstract-Book_ALL.pdf
Case Presentation: We present a case of a 48 year-old male with history of hyperlipidemia, HIV and latent secondary syphilis who presented for evaluation of loss of libido and erectile dysfunction for 2 months duration.
On examination, the patient was hemodynamically stable and did not show any signs and symptoms of adrenal insufficiency. The only physical finding was small testicular size. On lab work, his total testosterone level was 21.47 ng/dl. The corresponding luteinizing hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone and morning cortisol levels were also low. His serum electrolytes were within normal limits.
Upon reviewing his medication list, we found that the patient was taking Megace 800mg daily as an appetite stimulant. About 2 months prior to starting Megace, on lab work his Total and Free Testosterone levels were normal (548 ng/dl and 83 pg/ml respectively). FSH, LH, prolactin level, prostate specific antigen and sex binding globulin) were also normal at that time. Brain MRI was done which showed no pituitary mass and only a partial empty sella.
After excluding all other factors, Megace was deemed to be responsible for his Secondary Hypogonadism. Upon tapering Megace the patient immediately started showing improvement in his symptoms.
Discussion: Megestrol acetate (megace) is a synthetic progestin and is in use since the 1970s to treat advanced cancer, anorexia and weight loss especially in patients with HIV. It is also used as an appetite stimulant although the exact mechanism by which it stimulates appetite is still unknown.
Megace has been shown to cause suppression of the pituitary-adrenal axis due to its affinity for the glucocorticoid receptor. High doses or prolonged treatment with it may cause Cushing’s syndrome, hyperglycemia and suppression of ACTH and cortisol levels.
It has also been shown to cause suppression of the gonadal axis leading to symptomatic androgen deficiency. Megace also has profound effects on testosterone, reducing levels to near castration levels in elderly men and this could be a result of reduction in LH levels. Clinicians should be mindful of these side effects when prescribing Megace.
Conclusion: The hypothalamic-pituitary-adrenal and gonadal axis regulates thirst, mood, hunger, energy level, sexual function including libido. Physicians prescribing Megace should be aware of the possibility of suppression of the hypothalamic-pituitary-adrenal and gonadal axis by it and patients should be monitored accordingly.
http://am.aace.com/files/Abstract-Book_ALL.pdf
Case Presentation: We present a case of a 48 year-old male with history of hyperlipidemia, HIV and latent secondary syphilis who presented for evaluation of loss of libido and erectile dysfunction for 2 months duration.
On examination, the patient was hemodynamically stable and did not show any signs and symptoms of adrenal insufficiency. The only physical finding was small testicular size. On lab work, his total testosterone level was 21.47 ng/dl. The corresponding luteinizing hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone and morning cortisol levels were also low. His serum electrolytes were within normal limits.
Upon reviewing his medication list, we found that the patient was taking Megace 800mg daily as an appetite stimulant. About 2 months prior to starting Megace, on lab work his Total and Free Testosterone levels were normal (548 ng/dl and 83 pg/ml respectively). FSH, LH, prolactin level, prostate specific antigen and sex binding globulin) were also normal at that time. Brain MRI was done which showed no pituitary mass and only a partial empty sella.
After excluding all other factors, Megace was deemed to be responsible for his Secondary Hypogonadism. Upon tapering Megace the patient immediately started showing improvement in his symptoms.
Discussion: Megestrol acetate (megace) is a synthetic progestin and is in use since the 1970s to treat advanced cancer, anorexia and weight loss especially in patients with HIV. It is also used as an appetite stimulant although the exact mechanism by which it stimulates appetite is still unknown.
Megace has been shown to cause suppression of the pituitary-adrenal axis due to its affinity for the glucocorticoid receptor. High doses or prolonged treatment with it may cause Cushing’s syndrome, hyperglycemia and suppression of ACTH and cortisol levels.
It has also been shown to cause suppression of the gonadal axis leading to symptomatic androgen deficiency. Megace also has profound effects on testosterone, reducing levels to near castration levels in elderly men and this could be a result of reduction in LH levels. Clinicians should be mindful of these side effects when prescribing Megace.
Conclusion: The hypothalamic-pituitary-adrenal and gonadal axis regulates thirst, mood, hunger, energy level, sexual function including libido. Physicians prescribing Megace should be aware of the possibility of suppression of the hypothalamic-pituitary-adrenal and gonadal axis by it and patients should be monitored accordingly.
