Felipe H Duarte1, Raquel S Jallad, Marcello D Bronstein. 1. Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, 05403-000 São Paulo, Brazil.
Abstract
CONTEXT: Oral estrogens, alone or in combination with somatostatin receptor ligands, have been shown to control acromegaly in women. Selective estrogen receptor modulators resulted in similar effects in both genders. Clomiphene citrate (CC), a selective estrogen receptor modulator that increases LH and FSH secretion, improves hypogonadism and fertility outcomes. OBJECTIVE: To assess the impact of CC on serum IGF-1 and T levels in male acromegalic patients not controlled by surgery, radiotherapy, and/or medical treatment. STUDY DESIGN: In this prospective, open-label, single-center trial, CC (50 mg/d) was added to previous medical treatment for 3 months. Hormonal assessment was performed before and during the intervention. PATIENTS: Sixteen male patients (median age, 52.8 y; range, 36-79 y) met the following criteria: IGF-1 above the upper limit of normal range for at least 1 year despite the use of available medical therapies, and T levels within or below the third inferior tertile of normality. RESULTS: Serum IGF-1 levels decreased by 41% (mean ± SD, 424 ± 108 to 250 ± 83 ng/mL; P < .0004), leading 44% (seven of 16) of the patients to achieve normal IGF-1 levels. Total serum T levels increased by 209% (282 ± 201 to 497 ± 310 ng/dL), reaching normal levels in 67% (four of six) of those patients considered hypogonadal. CONCLUSIONS: Addition of CC should be considered an option in male acromegaly patients not controlled by current available options, with a considerable cost-saving benefit. Furthermore, improvement of T levels can be obtained in those patients with concurrent central hypogonadism.
CONTEXT: Oral estrogens, alone or in combination with somatostatin receptor ligands, have been shown to control acromegaly in women. Selective estrogen receptor modulators resulted in similar effects in both genders. Clomiphene citrate (CC), a selective estrogen receptor modulator that increases LH and FSH secretion, improves hypogonadism and fertility outcomes. OBJECTIVE: To assess the impact of CC on serum IGF-1 and T levels in male acromegalicpatients not controlled by surgery, radiotherapy, and/or medical treatment. STUDY DESIGN: In this prospective, open-label, single-center trial, CC (50 mg/d) was added to previous medical treatment for 3 months. Hormonal assessment was performed before and during the intervention. PATIENTS: Sixteen male patients (median age, 52.8 y; range, 36-79 y) met the following criteria: IGF-1 above the upper limit of normal range for at least 1 year despite the use of available medical therapies, and T levels within or below the third inferior tertile of normality. RESULTS: Serum IGF-1 levels decreased by 41% (mean ± SD, 424 ± 108 to 250 ± 83 ng/mL; P < .0004), leading 44% (seven of 16) of the patients to achieve normal IGF-1 levels. Total serum T levels increased by 209% (282 ± 201 to 497 ± 310 ng/dL), reaching normal levels in 67% (four of six) of those patients considered hypogonadal. CONCLUSIONS: Addition of CC should be considered an option in male acromegalypatients not controlled by current available options, with a considerable cost-saving benefit. Furthermore, improvement of T levels can be obtained in those patients with concurrent central hypogonadism.
Authors: Shlomo Melmed; Marcello D Bronstein; Philippe Chanson; Anne Klibanski; Felipe F Casanueva; John A H Wass; Christian J Strasburger; Anton Luger; David R Clemmons; Andrea Giustina Journal: Nat Rev Endocrinol Date: 2018-09 Impact factor: 43.330
Authors: Maria Fleseriu; Beverly M K Biller; Pamela U Freda; Monica R Gadelha; Andrea Giustina; Laurence Katznelson; Mark E Molitch; Susan L Samson; Christian J Strasburger; A J van der Lely; Shlomo Melmed Journal: Pituitary Date: 2020-10-20 Impact factor: 4.107