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Adverse Effects of Large Doses of Medroxyprogesterone Acetate (MPA) in Idiopathic Isosexual Precocity

Three girls and one boy with isosexual precocity were treated with large intramuscular doses of MPA, 200–300 mg q. 7–10 d., in an attempt to control the rapid advancement of skeletal maturation. Although secondary sexual development regressed, all four developed signs suggestive of corticoid excess. These included rapid weight gain, mild hypertension, plethoric facies, increased body hair, and inappropriate insulin responses to glucose and arginine. In the presence of these signs of corcoid exctiess, rapid linear growth and skeletal maturation continued in all patients. Fasting growth hormone levels and acute responses to insulin and 1-arginine remained within normal limits. Urinary testosterone in the boy decreased from 15.1 μg/24 h before treatment to 1.2 μg/24 h; however, further testicular enlargement occurred during therapy.Adrenal function in the two patients so studied revealed pituitary-adrenal suppression. Excretion of Porter-Silber (P-S) chromogens was within normal limits and not suppressed by dexamethasone. Neither patient responded to metyrapone or ACTH. Thus, it is likely that the urinary steroids measured as P-S chromogens were derived from MPA rather than from endogenous adrenal corticoids.Experience with these patients suggests that bone advancement cannot be arrested with larger doses of MPA without producing potentially hazardous side effects.