OR19-3 Subclinical Adrenal Insufficiency in Endometriosis Patients Treated with Depot Medroxyprogesterone Acetate

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR19-Female Reproductive Endocrinology
Sunday, June 16, 2013: 11:15 AM-12:45 PM
Presentation Start Time: 11:45 AM
Room 102 (Moscone Center)
Paweena Chunharojrith*, Apiradee Sriwijitkamol, Surasak Angsuwathana and Sathit Vannasaeng
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background: Hypothalamic-pituitary-adrenal (HPA) suppression has been reported in cancer patients receiving high dose medroxyprogesterone acetate, because of its glucocorticoid-like activity. However, the HPA suppression in endometriosis patients treated with depot-medroxyprogesterone acetate (DMPA), a microcrystalline suspension of medroxyprogesterone acetate, have never been reported. This study was conducted to determine an effect of DMPA on HPA-axis in endometriosis patients.

Methods: Thirty-nine endometriosis patients were recruited. The mean age of the subjects was 36.1±5.4 years and BMI of 23.1±2.9 kg/m2. Before-and-After design study was conducted in 12 therapy-naïve endometriosis patients (naïve-DMPA group). HPA-axis in naïve-DMPA patients was assessed by the low dose (1 µg) and high dose (250 µg) ACTH stimulation test before receiving DMPA and after DMPA treatment (150 mg intramuscular injection every month for 6-9 months). Cross-sectional design study was performed in 27 patients previously treated with DMPA (pre-DMPA group). The low and high dose ACTH tests were performed once in pre-DMPA patients at 6-9th month after treatment. The mean duration of DMPA treatment in pre-DMPA group was 5.9±0.9 months. Impaired response to ACTH test was defined as the peak cortisol level after ACTH test of less than 18 µg/dl.

Results: Seventeen of 39 DMPA-treated patients (43.6%) had subclinical adrenal insufficiency, as indicated by an impaired response to 1 µg ACTH test [6 of 12 (50%) in the naïve-DMPA group and 11 of 27 (40.7%) in the pre-DMPA group]. Only 1 of 39 patients had inadequate HPA response during the 250 µg ACTH test. Cortisol level at T0 and peak cortisol response after 1 µg ACTH test was significant lower in subclinical adrenal insufficiency patients than those with normal adrenal function (8.0±2.5 vs. 11.7±4.4 µg/dl, P=0.004 and 15.6±1.8 vs. 21.4±3.2 µg/dl, P=0.01). In the naïve-DMPA group, baseline cortisol level at T0 was not different between subclinical adrenal insufficiency and patients with normal HPA axis (12.1±4.9 vs. 12.2±3.6 µg/dl). After DMPA treatment, cortisol level at Twas lower than baseline level in both subclinical adrenal insufficiency and patients with normal HPA axis (7.8±2.8 vs. 12.1±4.9 µg /dl and 10.0±3.2 vs. 12.2±3.6 µg/dl, respectively). The impaired HPA response during the 1 µg ACTH test was observed since 6 months after DMPA treatment. Of 17 patients who had subclinical adrenal insufficiency, only 1 patient reported adrenal insufficiency symptoms.

Conclusions: There is a high prevalence of impaired adrenal reserve in endometriosis patients treated with DMPA for 6-9 months. The 1 µg ACTH test is more sensitive for detecting subclinical adrenal insufficiency than the 250 µg ACTH stimulation test. Administration of additional corticosteroid replacement should be considered during periods of acute illness in these patients.

Nothing to Disclose: PC, AS, SA, SV

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Siriraj Grant for Research Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand