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Megestrol acetate (megace) is used to boost appetite and weight in AIDS patients with cachexia (see ACC, Nov 94, p 96). Theoretically, because it is a progestin, high doses could have glucocorticoid activity leading to suppression of the hypothalamic-pituitary-adrenal axis.
Investigators at Albany Medical College report a case of adrenal insufficiency in an AIDS patient that was apparently induced by megace. The patient had been taking megace for four years and abruptly discontinued it 14 days before presenting with weight loss, vomiting, severe fatigue, and orthostatic hypotension. He had abnormally low basal cortisol and ACTH levels and a poor response to a short-term cosyntropin-stimulation test, but he did respond to a three-day test. Re…