be harmful, and the package insert from schering ag recommends the daily dose be reduced by no more than 50 mg at intervals of several weeks. the concern is the manner in which cpa affects the adrenal glands. due to its glucocorticoid activity, high levels of cpa may reduce acth, resulting in adrenal insufficiency if discontinued abruptly. in addition, although cpa reduces androgen production in the gonads, it can increase the production of adrenal androgens, in some cases resulting in an overall rise in testosterone levels. thus, the sudden withdrawal of cpa could result in undesirable androgenic effects. this is a particular concern because androgens, especially dht, suppress adrenal function, further reducing corticosteroid production. suppression of adrenal function and reduced response to adrenocorticotropic hormone (acth) have been reported with cpa treatment. as a result, adrenal insufficiency and hence low cortisol and aldosterone levels and acth responsiveness can occur upon discontinuation of cpa. low aldosterone levels may lead to hyponatremia (sodium loss) and hyperkalemia (excess potassium). patients taking cpa should have their cortisol levels and electrolytes monitored, and if hyperkalemia develops, should reduce the consumption of foods with high potassium content or discontinue the medication.