Sexual Abuse: A Journal of Research and Treatment, Vol. 18, No. 2, April 2006 (
Prescription of Medroxyprogesterone Acetate
to a Patient with Pedophilia, Resulting in Cushing’s
Syndrome and Adrenal Insufﬁciency
Richard B. Krueger,
and Michael Hill
Published online: 26 July 2006
This article provides a case report of a patient with pedophilia who was treated
over a 4-year period with medroxyprogesterone acetate (MPA) at a dose of 300
mg/day and as a consequence developed Cushing’s Syndrome and adrenal insuf-
ﬁciency, for which he was treated and from which he recovered. He also reported
a hypersexual reaction to his own past cessation of MPA. Gonadotropin-releasing
hormone agonists, which have a more benign side-effect proﬁle than MPA, are
suggested as an alternative to MPA.
KEY WORDS: medroxyprogesterone acetate; LRHR agonists; leuprolide acetate; antiandrogens;
sex offenders; paraphilia; Cushing’s syndrome; adrenal insufﬁciency; hypersexual behavior.
Medroxyprogesterone acetate (MPA) has been used for years to treat patients
with paraphilias (Rosler & Witztum, 2000) and shares some of the pharmacological
properties of glucocorticoids (Dux et al., 1998). Use of MPA in doses comparable
to those used to treat individuals with paraphilias has been reported as being
associated with Cushing’s Syndrome and adrenal insufﬁciency in patients with
cancer (Dux et al., 1998; Malik, Wakelin, Dean, Cove, & Wood, 1996) and adrenal
suppression has been reported in patients treated with MPA for premature puberty
(Sadeghi-Nejad, Kaplan, & Grumbach, 1971). To our knowledge we offer the ﬁrst
Department of Psychiatry, Columbia University, College of Physicians and Surgeons, and Medical
Director, Sexual Behavior Clinic, New York State Psychiatric Institute, Unit #45, 1051 Riverside
Drive, New York, NY, 10032.
Departments of Medicine and Obstetrics-Gynecology, Columbia University Medical Center, New
York, NY, 10032.
New York State Ofﬁce of Mental Health, Central New York Psychiatric Center, Marcy, NY, 13403.
To whom correspondence should be addressed at Department of Psychiatry, Columbia University, Col-
lege of Physicians and Surgeons, and Medical Director, Sexual Behavior Clinic, New York State Psy-
chiatric Institute, Unit #45, 1051 Riverside Drive, New York, NY, 10032; e-mail: firstname.lastname@example.org.
2006 Springer Science+Business Media, Inc.