title: Estrogens and selective estrogen receptor modulators in acromegaly.
abstract: Despite recent advances in acromegaly treatment by surgery, drugs, and radiotherapy, hormonal control is still not achieved by some patients. The impairment of IGF-1 generation by estrogens in growth hormone deficient patients is well known. Patients on oral estrogens need higher growth hormone doses in order to achieve normal IGF-1 values. In the past, estrogens were one of the first drugs used to treat acromegaly. Nevertheless, due to the high doses used and the obvious side effects in male patients, this strategy was sidelined with the development of more specific drugs, as somatostatin receptor ligands and dopamine agonists. In the last 15 years, the antagonist of growth hormone receptor became available, making possible IGF-1 control of the majority of patients on this particular drug. However, due to its high cost, pegvisomant is still not available in many centers around the world. In this setting, the effect of estrogens and also of selective estrogen receptor modulators on IGF-1 control was reviewed, and proved to be an ancillary tool in the management of acromegaly. This review describes data concerning their efficacy and place in the treatment algorithm of acromegaly.
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.|Endocrinology Service, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Felipe H
authors.initials: FH
authors.lastname: Duarte
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Raquel S
authors.initials: RS
authors.lastname: Jallad
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil. mdbronstein@uol.com.br.
authors.forename: Marcello D
authors.initials: MD
authors.lastname: Bronstein
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
chemical_list: D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators
keywords: Acromegaly; Clomiphene; Estrogen; Raloxifen; SERMs; Tamoxifen