ECE2019 Poster Presentations Pituitary and Neuroendocrinology 3 (73 abstracts)
The impact of clomiphene citrate as add-on therapy in male acromegalic patients non-responsive to combined medical therapy
Lucio Vilar 1, , Clarice Vilar 2, , Luciano Albuquerque 1 , Erik Trovão 1 , Ana Carolina Thé 1 , Patricia Gadelha 1 , Renata Campos 1 , Izabela Cardoso 1 , Thaíse Borges 1 & Ruy Lyra 1
1Division of Endocrinology, Hospital das Clinicas, Pernambuco Federal University, Recife, Brazil; 2Pernambuco Endocrine Research Center, Recife, Brazil; 3Olinda Medical School (FMO), Olinda, Brazil.
Introduction: Clomiphene citrate (CC), a selective estrogen receptor modulator that increases LH and FSH secretion, improves hypogonadism and fertility outcomes. Moreover, there is limited evidence that it may also be helpful as add-on therapy to normalize IGF-1 levels in male acromegalic patients.
Objective: To assess the effect impact of CC on serum IGF-1 and testosterone levels in male acromegalic patients not controlled by the combination of lanreotide autogel (a first generation somatostatin analogue) and cabergoline (a dopamine agonist).
Study Design: In this prospective, open-label, single-center trial, CC (50 mg/day) was added to previous medical treatment (combination of lanreotide autogel and cabergoline) for 3 months. Hormonal assessment (GH, IGF-1 and testosterone levels) was performed before and 3 months after CC introduction.
Patients: Eight male patients (mean age, 40.75 ± 9.32 years; median age, 42 years; range, 26–54 years) met the following criteria: IGF-1 above the upper limit of normal (ULN) range for at least 1 year despite the use of combined medical therapy.
Results: Three months after CC introduction, serum IGF-1 levels decreased in all patients and reached normal values in 2 patients (25%). Noteworthy, IGF-1 normalization occurred in two of the three patients (66.7%) with baseline IGF-1 levels of up to 2 times the ULN. There was no significant change in GH levels. Conversely, total serum testosterone levels increased in all patients, reaching normal levels in 50% (three of six) of those considered to be hypogonadal (total testosterone < 300 ng/dL). Overall, CC was well tolerated and no patient needed to interrupt the treatment.
Conclusion: Addition of the low cost CC may be hepful to normalize IGF-1 levels in male acromegalic patients not controlled by the combination of SAs and cabergoline, particularly those with mild IGF-1 elevation (up to two times the ULN). Moreover, improvement of testosterone levels can be obtained in patients with concurrent central hypogonadism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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