Mehta Kunal, Weiss Irene, Goldberg Michael D
Westchester Medical Center, Department of Medicine, Division of Endocrinology, Taylor Care Pavilion, Room D342, 100 Woods Road, Valhalla, NY 10595, USA.
Case Rep Endocrinol. 2015;2015:147265. doi: 10.1155/2015/147265. Epub 2015 Dec 6.
Megestrol acetate (MA) is a synthetic progestin with both antineoplastic and orexigenic properties. In addition to its effects on the progesterone receptor, MA also binds the glucocorticoid receptor. Some patients receiving MA therapy have been reported to develop clinical features of glucocorticoid excess, while others have experienced the clinical syndrome of cortisol deficiency-either following withdrawal of MA therapy or during active treatment. We describe a patient who presented with clinical and biochemical features of central adrenal insufficiency. Pituitary function was otherwise essentially normal, and the etiology of the isolated ACTH suppression was initially unclear. The use of an exogenous glucocorticoid was suspected but was initially denied by the patient; ultimately, the culprit medication was uncovered when a synthetic steroid screen revealed the presence of MA. The patient's symptoms improved after she was switched to hydrocortisone. Clinicians should be aware of the potential effects of MA on the hypothalamic-pituitary-adrenal (HPA) axis.
醋酸甲地孕酮（MA）是一种具有抗肿瘤和促食欲特性的合成孕激素。除了对孕激素受体有作用外，MA还能与糖皮质激素受体结合。据报道，一些接受MA治疗的患者会出现糖皮质激素过量的临床特征，而另一些患者则在MA治疗停药后或积极治疗期间出现皮质醇缺乏的临床综合征。我们描述了一名表现为中枢性肾上腺功能不全临床和生化特征的患者。垂体功能在其他方面基本正常，最初孤立性促肾上腺皮质激素（ACTH）抑制的病因尚不清楚。怀疑使用了外源性糖皮质激素，但患者最初否认；最终，当合成类固醇筛查显示存在MA时，找到了罪魁祸首药物。患者改用氢化可的松后症状有所改善。临床医生应意识到MA对下丘脑-垂体-肾上腺（HPA）轴的潜在影响。
