Successful Treatment of Acromegaly and Associated Hypogonadism with First-Line Clomiphene Therapy

Abstract

Clomiphene citrate (CC) has been reported as an effective add-on therapy to somatostatin analogs and dopamine agonists in patients with acromegaly accompanied by hypogonadism; its use as a single agent to treat acromegaly and associated hypogonadism following incomplete surgery has not been previously reported. We report the first case in which clomiphene was utilized as a single agent for the dual management of acromegaly and hypogonadism, not controlled by pituitary surgery alone. The treatment was well tolerated and proved to be effective after a process of treatment withdrawal and reintroduction. We propose that clomiphene may be considered as a cost-effective oral treatment option in select cases of hypogonadal acromegaly.

Approach of Acromegaly during Pregnancy

“…Hypogonadism requires estrogen/progesterone, respective testosterone substitution, while hypogonadotropic hypogonadism in females and males with aggressive pituitary tumors that are partially responsive to standard therapy might be treated with gonadotropins or Gonadotropin Releasing Hormone (GnRH) protocols to increase the fertility potential [ 50 ]. Alternatively, the use of clomiphene citrate, a selective estrogen receptor modulator (SERM), stimulates LH and FSH (Follicle Stimulating Hormone) with good results on fertility rates; the drug was proposed as an add-on therapy added to acromegaly accompanied by hypogonadism which is not controlled by SSAs and/or DAs [ 59 , 60 , 61 ]. However, despite well-known fertility issues in acromegalic patients, spontaneous pregnancy has been reported [ 51 ].…”

“…Pregnancy in acromegalic females, an unusual aspect, is reported spontaneously despite infertility concerns, as mentioned earlier, or due to the use of ovulation inductors, GnRH or gonadotropines and, lately, via assisted reproductive techniques [ 50 , 51 , 59 , 60 , 75 ]. Interestingly, the acromegaly in these women was either diagnosed previously and treated with one, two or all three lines of management (including radiotherapy) or it was diagnosed for the first time during gestation, which challenges the biochemistry assessments due to placental GH overlap [ 40 , 41 ].…”