Estrogens and selective estrogen receptor modulators in acromegaly

Area of Science:

• Endocrinology
• Pharmacology

Background:

• Acromegaly treatment advances include surgery, drugs, and radiotherapy, but hormonal control remains challenging for some patients.
• Estrogens are known to impair insulin-like growth factor 1 (IGF-1) generation in growth hormone-deficient individuals, necessitating higher growth hormone doses.
• Historically, estrogens were used for acromegaly but were sidelined due to high doses and side effects, with newer agents like somatostatin receptor ligands and dopamine agonists emerging.

Purpose of the Study:

• To review the efficacy of estrogens and selective estrogen receptor modulators (SERMs) as ancillary treatments for acromegaly.
• To evaluate the place of these agents in the current acromegaly treatment algorithm.
• To provide data on IGF-1 control using estrogen-based therapies.

Main Methods:

• Review of existing literature on the use of estrogens and SERMs in acromegaly management.
• Analysis of data regarding IGF-1 control and efficacy of these agents.
• Assessment of their role as an ancillary tool in acromegaly treatment algorithms.

Main Results:

• Estrogens and SERMs have demonstrated potential as ancillary tools for IGF-1 control in acromegaly.
• These agents can be considered when standard therapies are insufficient or unavailable, such as pegvisomant.
• The review compiles data on their efficacy and suitability within treatment strategies.

Conclusions:

• Estrogen-based therapies, including SERMs, represent a viable ancillary option for acromegaly management.
• Their use can aid in achieving IGF-1 control, particularly when cost-prohibitive treatments like pegvisomant are inaccessible.
• Further data supports their integration into acromegaly treatment algorithms as supplementary options.