Treatment of mastalgia with tamoxifen in male patients with liver cirrhosis: a randomized crossover study.
OBJECTIVE
Mastalgia is occasionally found in patients with liver cirrhosis, especially in those receiving spironolactone for treatment of ascites. The pathogenesis is still unclear. Estrogen excess in cirrhotic patients and estrogenic effects of the spironolactone are possible leading causes. Treatment directed against the preponderance of estrogenic stimulation in these patients has never been investigated. This study was designed to investigate the efficacy and safety of tamoxifen, an estrogen antagonist, on mastalgia in patients with liver cirrhosis.


METHODS
A total of 16 male cirrhotic patients with mastalgia were randomly assigned to two groups. One group was treated with tamoxifen (20 mg p.o., b.i.d.) for 1 month, followed by placebo for the next month. The other group was treated in the reverse order. All patients received spironolactone for ascites and/or peripheral edema, and the drug was continued during the study period. The size of the breasts and the degree of breast pain and tenderness were recorded in all subjects before and after the treatment periods. Serum levels of estradiol and testosterone were measured using the radioimmunoassay method.


RESULTS
Of the 16 patients, 14 experienced a decrease or disappearance of the breast pain and/or tenderness during the tamoxifen treatment period, whereas only two of the 16 patients felt an improvement during the placebo period (p < 0.05). There were significant improvements in the breast pain and tenderness scores and decreases in the breast sizes during the tamoxifen treatment period (before vs after: 1.4+/-0.3 vs 0.4+/-0.2, p = 0.002; 1.9+/-0.2 vs 0.5+/-0.2, p < 0.001; and 6.8+/-0.6 vs 5.5+/-0.6 cm, p = 0.02, respectively), whereas no obvious change was seen during the placebo period. Serum levels of estradiol and testosterone did not change significantly after the tamoxifen or placebo treatments (p > 0.05). No major side effects were noted during the therapeutic periods.


CONCLUSIONS
Tamoxifen is effective and safe in the management of mastalgia in male cirrhotic patients taking spironolactone.
Li
C P
CP
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Lee
F Y
FY
Hwang
S J
SJ
Chang
F Y
FY
Lin
H C
HC
Kuo
B I
BI
Chu
C J
CJ
Lee
S D
SD
D000368:Aged; D001940:Breast; D018592:Cross-Over Studies; D004958:Estradiol / Q000097:blood; D004965:Estrogen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D016037:Single-Blind Method; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D004965:Estrogen Antagonists; D013629:Tamoxifen; D013148:Spironolactone; D013739:Testosterone; D004958:Estradiol