Duarte FH, Jallad RS, Bronstein MD. Clomiphene citrate for treatment of acromegaly not controlled by conventional therapies. The Journal of Clinical Endocrinology & Metabolism. http://press.endocrine.org/doi/abs/10.1210/jc.2014-3913
Context: Oral estrogens, alone or in combination with somatostatin receptor ligants, have been shown to control acromegaly in women. Selective estrogen receptor modulators (SERMs) resulted in similar effects in both genders. Clomiphene citrate (CC), a SERM that increases LH and FSH secretion, improves hypogonadism and fertility outcomes.
Objective: To assess the impact of CC on serum IGF-1 and testosterone 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/day) was added to previous medical treatment for 3 months. Hormonal assessment was performed prior to and during the intervention
Patients: Sixteen male patients (median age: 52.8 years, range 36–79 years) met the following criteria: IGF-1 above the upper limit of normal range (ULNR) for at least one year despite the use of available medical therapies, and testosterone levels within or below the third inferior tercile of normality.
Results: Serum IGF-1 levels decreased by 41% (mean ±S D) (424 ± 108 ng/mL to 250 ± 83 ng/mL, P < 0.0004) leading 44%(7/16) of patients to achieve normal IGF-1 levels. Total serum testosterone levels increased by 209% (282 ± 201 ng/dL to 497 ± 310 ng/dL), reaching normal levels in 67% (4/6) 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 testosterone levels can be obtained in those patients with concurrent central hypogonadism.
Context: Oral estrogens, alone or in combination with somatostatin receptor ligants, have been shown to control acromegaly in women. Selective estrogen receptor modulators (SERMs) resulted in similar effects in both genders. Clomiphene citrate (CC), a SERM that increases LH and FSH secretion, improves hypogonadism and fertility outcomes.
Objective: To assess the impact of CC on serum IGF-1 and testosterone 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/day) was added to previous medical treatment for 3 months. Hormonal assessment was performed prior to and during the intervention
Patients: Sixteen male patients (median age: 52.8 years, range 36–79 years) met the following criteria: IGF-1 above the upper limit of normal range (ULNR) for at least one year despite the use of available medical therapies, and testosterone levels within or below the third inferior tercile of normality.
Results: Serum IGF-1 levels decreased by 41% (mean ±S D) (424 ± 108 ng/mL to 250 ± 83 ng/mL, P < 0.0004) leading 44%(7/16) of patients to achieve normal IGF-1 levels. Total serum testosterone levels increased by 209% (282 ± 201 ng/dL to 497 ± 310 ng/dL), reaching normal levels in 67% (4/6) 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 testosterone levels can be obtained in those patients with concurrent central hypogonadism.
