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Case Reports
. 2025 Sep 27:61:101961.
doi: 10.1016/j.gore.2025.101961. eCollection 2025 Oct.

Adrenal insufficiency after megestrol acetate for fertility-sparing treatment of endometrial cancer

Lauren Clarfield  1 , Laura Diamond  1 , Soyoun Rachel Kim  1   2 , Shima Deljoomanesh  2 , Nashwah Taha  3 , Shereen Ezzat  4 , Eleni Dimaraki  5 , Sarah E Ferguson  1   2
Affiliations
Case Reports

Adrenal insufficiency after megestrol acetate for fertility-sparing treatment of endometrial cancer

Lauren Clarfield et al. Gynecol Oncol Rep. .

Abstract

•AI is a rare yet potentially life-threatening side effect of MA when used for fertility sparing for EC/AH.•The presentation of AI is highly variable and clinicians should employ a low threshold for investigations.•AI can occur while on MA therapy or after abrupt withdrawal; MA should be tapered upon discontinuation.•Patients on MA may require stress dosing at times of surgery/procedures or acute illness.•Consider progestin IUD as a first line therapy, especially in patients with metabolic comorbidities.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. A
Fig. A
(1) Normal functioning hypothalamic–pituitary–adrenal (HPA) axis whereby sufficient circulating cortisol inhibits the release of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) through negative feedback (2) The role of megestrol acetate (MA) as a progesterone and glucocorticoid receptor agonist and its impact on the hypothalamic–pituitary–adrenal (HPA) axis. CRH = corticotropin-releasing hormone; ACTH = adrenocorticotropic hormone.
Fig. B
Fig. B
Timeline of case 1 and 2. AH = atypical hyperplasia; AI = adrenal insufficiency; BID = twice daily; D&C = dilation and curettage; EC = endometrial cancer; ED = emergency department; GA = general anesthesia; IUD = intrauterine device; m = momth; MA = megestrol acetate; PO = per os; T2DM = type 2 diabetes mellitus.
See this image and copyright information in PMC

References

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