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Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression.

Publication ,  Journal Article
Orme, LM; Bond, JD; Humphrey, MS; Zacharin, MR; Downie, PA; Jamsen, KM; Mitchell, SL; Robinson, JM; Grapsas, NA; Ashley, DM
Published in: Cancer
July 15, 2003

BACKGROUND: Despite the widespread use of megestrol acetate (MA) among a growing number of pediatric oncology departments, there is only one published study on the use of MA in children with malignant disease. The objectives of the current study were to examine the effect of MA in improving the nutritional status of children with malignant disease and to describe and consider the implications of MA-associated adrenal suppression that was found consistently. METHODS: Medical records of 19 children with malignant disease who were treated with MA were reviewed. During MA therapy, clinical assessments every 4 weeks included anthropometrics, caloric intake, quality-of-life scores, and appetite scores. Serum cortisol levels, lipid profiles (including cholesterol levels) random blood glucose levels, and coagulation screening were measured at 4-6-week intervals. RESULTS: MA use was associated with significant increases in weight, weight z score, middle-upper arm circumference, triceps skin-fold thickness, appetite, and caloric intake. MA was extremely useful in aiding the efficient tapering of nasogastric feeds. However, a significant and potentially dangerous decrease in cortisol was seen in 10 of 11 patients tested, with 1 patient who manifested clinical hypoadrenalism with hemodynamic collapse, requiring inotropic support. This is the first report of MA-associated clinical adrenal suppression in a child with malignant disease. CONCLUSIONS: Although the results of this study support the ability of MA to improve nutritional status, its use was complicated by severe adrenal suppression in almost all patients tested, with a serious clinical adverse event occurring in one patient. Routine hydrocortisone supplementation throughout MA treatment should be considered as well as larger doses for patients with acute illness and patients who undergo surgery.

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Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

July 15, 2003

Volume

98

Issue

2

Start / End Page

397 / 405

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Treatment Outcome
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Nutritional Status
  • Megestrol Acetate
  • Medulloblastoma
  • Male
  • Kidney Neoplasms
  • Infant
 

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Orme, L. M., Bond, J. D., Humphrey, M. S., Zacharin, M. R., Downie, P. A., Jamsen, K. M., … Ashley, D. M. (2003). Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression. Cancer, 98(2), 397–405. https://doi.org/10.1002/cncr.11502
Orme, Lisa M., Jodie D. Bond, Maureen S. Humphrey, Margaret R. Zacharin, Peter A. Downie, Kris M. Jamsen, Susan L. Mitchell, Jacqueline M. Robinson, Natalie A. Grapsas, and David M. Ashley. “Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression.Cancer 98, no. 2 (July 15, 2003): 397–405. https://doi.org/10.1002/cncr.11502.
Orme LM, Bond JD, Humphrey MS, Zacharin MR, Downie PA, Jamsen KM, et al. Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression. Cancer. 2003 Jul 15;98(2):397–405.
Orme, Lisa M., et al. “Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression.Cancer, vol. 98, no. 2, July 2003, pp. 397–405. Pubmed, doi:10.1002/cncr.11502.
Orme LM, Bond JD, Humphrey MS, Zacharin MR, Downie PA, Jamsen KM, Mitchell SL, Robinson JM, Grapsas NA, Ashley DM. Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression. Cancer. 2003 Jul 15;98(2):397–405.
Journal cover image

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

July 15, 2003

Volume

98

Issue

2

Start / End Page

397 / 405

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Treatment Outcome
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Nutritional Status
  • Megestrol Acetate
  • Medulloblastoma
  • Male
  • Kidney Neoplasms
  • Infant