Estroprogestinic pill normalizes IGF-I levels in acromegalic women.
In some acromegalic patients medical treatment does not succeed in normalizing GH/IGF-I values. Data showing IGF-I suppression in acromegaly by estrogen and by tamoxifen use prompted us to reevaluate the effects of estroprogestins (EP) supplementation on GH/IGF-I levels in acromegalic women resistant or only partially sensitive to medical treatment. Eight active acromegalic women (30-52 yr, 4 with regular menses) entered a prospective open pilot study. Three of them, resistant to medical treatment, were off therapy; the remaining five, partially sensitive, maintained it at the maximally effective dosages throughout the study. Patients were treated with a triphasic pill (ethynil-estradiol 30-40-30 microg/day and desogestrel 50-70-100 mg/day) for 13 +/- 7 months. IGF-I levels fell from 512 (median, interquartile 436-657) microg/l to 282 (244-526) microg/l (p=0.0414); the decrease was observed in 6 patients (75%), and normal values were reached in 4 (50%). GH levels did not change [basal 7.6 (6.2-8.6) microg/l, final 7.6 (6.5-8.3) microg/l]. Effectiveness of treatment was not dependent on concomitant anti-GH treatment or gonadal status. In all patients IGF-I levels re-increased after EP withdrawal. This pilot study shows a marked IGF-I lowering effect of pill in acromegalic women, and warrants a prospective randomized study in patients resistant or partially sensitive to other medical treatments.
Cozzi
R
R
Division of Endocrinology, Niguarda Hospital, Milan, Italy. renatocozzi@tiscali.it
Barausse
M
M
Lodrini
S
S
Lasio
G
G
Attanasio
R
R
D000172:Acromegaly / Q000097:blood* / Q000188:drug therapy*; D000328:Adult; D003280:Contraceptives, Oral, Synthetic / Q000494:pharmacology* / Q000627:therapeutic use; D017135:Desogestrel / Q000494:pharmacology* / Q000627:therapeutic use; D004967:Estrogens / Q000494:pharmacology / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000187:drug effects* / Q000378:metabolism; D008875:Middle Aged; D010865:Pilot Projects; D011372:Progestins / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies
D003280:Contraceptives, Oral, Synthetic; D004967:Estrogens; D011372:Progestins; D004997:Ethinyl Estradiol; D007334:Insulin-Like Growth Factor I; D017135:Desogestrel