Clomiphene citrate for treatment of acromegaly not controlled by conventional therapies

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.

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.

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.

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.

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.

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.