Childhood virilization and adrenal suppression after ingestion of methandienone and cyproheptadine

J Pediatr Endocrinol Metab. 2009 May;22(5):459-62. doi: 10.1515/jpem.2009.22.5.459.


We report a combination of precocious pseudopuberty and adrenal insufficiency in a 4 year-old boy who had received an off-label 'appetite stimulant' syrup and excessive virilization in a 2 year-old girl who had received the same medication. Both patients presented with excessive virilization for a period of approximately 1-2 years. The syrup contains cyproheptadine and methandienone, a derivative of testosterone. Both cyproheptadine and methandienone were responsible for severe adrenal suppression in the boy. Methandienone undoubtedly caused precocious virilization in both children. Cessation of the syrup led to partial regression of virilization in both children and normalization of adrenal reserve function in the boy.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Glands / drug effects
  • Adrenal Insufficiency / chemically induced
  • Adrenal Insufficiency / complications
  • Appetite Stimulants / adverse effects*
  • Child, Preschool
  • Cyproheptadine / adverse effects*
  • Drug Combinations
  • Female
  • Humans
  • Male
  • Methandrostenolone / adverse effects*
  • Puberty, Precocious / chemically induced*
  • Puberty, Precocious / complications
  • Treatment Outcome
  • Virilism / chemically induced*


  • Appetite Stimulants
  • Drug Combinations
  • Cyproheptadine
  • Methandrostenolone