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.
Highlights
Hypogonadism is commonly observed in men with acromegaly, reported in 54% of patients with macroadenomas and 38% patients with microadenomas [1]
A recent study reported efficacy of clomiphene citrate (CC) as an add-on therapy for men with acromegaly not controlled by existing therapies and either low or low-normal serum testosterone [3]
There are no existing reports of the effects of CC as single agent or first-line therapy for hypogonadism in males with persistent acromegaly accompanied by hypogonadism following Transsphenoidal surgery (TSR)
Summary
Hypogonadism is commonly observed in men with acromegaly, reported in 54% of patients with macroadenomas and 38% patients with microadenomas [1]. The potential mechanisms explaining the occurrence of hypogonadism in acromegaly include mass effect with compression of the pituitary gland or stalk and hyperprolactinemia. Transsphenoidal surgery (TSR) is the primary therapy in most cases of acromegaly; the remission rate following surgery is 80-90 % for microadenomas and 40–50 % for macroadenomas [2]. A recent study reported efficacy of clomiphene citrate (CC) as an add-on therapy for men with acromegaly not controlled by existing therapies and either low or low-normal serum testosterone [3].
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