Clomiphene citrate for treatment of acromegaly not controlled by conventional therapies.
BACKGROUND
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.


METHODS
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.


METHODS
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.
Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, 05403-000 São Paulo, Brazil.
Felipe H
FH
Duarte
Raquel S
RS
Jallad
Marcello D
MD
Bronstein
D000172:Acromegaly / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D002996:Clomiphene / Q000627:therapeutic use*; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000188:drug therapy*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D013739:Testosterone; D007334:Insulin-Like Growth Factor I