Estrogens and selective estrogen receptor modulators in acromegaly

  title={Estrogens and selective estrogen receptor modulators in acromegaly},
  author={Felipe H. G. Duarte and Raquel Soares Jallad and Marcello Delano Bronstein},
Despite recent advances in acromegaly treatment by surgery, drugs, and radiotherapy, hormonal control is still not achieved by some patients. The impairment of IGF-1 generation by estrogens in growth hormone deficient patients is well known. Patients on oral estrogens need higher growth hormone doses in order to achieve normal IGF-1 values. In the past, estrogens were one of the first drugs used to treat acromegaly. Nevertheless, due to the high doses used and the obvious side effects in male… 
This Primer by Colao and colleagues reviews the pathogenesis, diagnosis and management of acromegaly and discusses the quality of life of patients and future outlooks.
The significance of estrogen receptors in acromegaly: Are they useful as predictors of prognosis and therapy regimen?
  • Selma Ozturk, H. Donmez-Altuntas, F. Bayram
  • Medicine, Biology
    Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society
  • 2020
Preoperative treatment of growth hormone (GH) producing macroadenomas with somatostatin receptor ligands (SRLs) to improve surgical outcome: a critical analysis
While all prospective studies suggested better surgical outcome for SRL-pretreated tumors 3 months post surgery, the differences in outcomes between pretreated and untreated control patients disappeared after 6–12 months.
Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly
Premenopausal women with acromegaly tend to have larger tumors, more aggressive tumor types, and lower remission rates than do men, and further studies on the clinical implications are needed.
Silent somatotroph pituitary adenomas: an update
Silent growth hormone adenomas (SGHA) are a rare entity of non-functioning pituitary neuroendocrine tumors that are often uncovered by investigation for headaches or oligoamenorrhea.
Effects of anti-estrogens on cell invasion and survival in pituitary adenoma cells: A systematic study
Pituitary Diseases and Bone
Treatment of pituitary hormone excess and deficiency generally improves skeletal health, although some patients remain at high risk of fractures, and treatment with bone-active drugs may become mandatory.
Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism.
The different etiologies of hypopituitarism are discussed and one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH are addressed.
Gender differences and temporal trends over two decades in acromegaly: a single center study in 112 patients
Gender-specific characteristics and an evolving spectrum of clinical presentation with implications for earlier diagnosis and personalized management of acromegaly are demonstrated.
Acromegaly: Current Challenges and Future Directions in Latin America
The clinical and biochemical characterization of patients with acromegaly in the authors' region does not seem to be different from that described in the international literature; however, population studies are necessary to establish the epidemiological trends in Latin America.


Estrogen treatment for acromegaly
Adding estrogen treatment to their ongoing medical treatment, suppressed IGF-1 significantly in all patients, achieving hormonal remission in three of them, and could be an alternative, inexpensive adjuvant treatment for females with active acromegaly.
Tamoxifen as a therapeutic agent in acromegaly
Tamoxifen might be useful in the treatment of patients with biochemically-mild active acromegaly, but longer term studies are warranted.
Clomiphene citrate for treatment of acromegaly not controlled by conventional therapies.
Addition of CC should be considered an option in male acromegaly patients not controlled by current available options, with a considerable cost-saving benefit, and improvement of T levels can be obtained in those patients with concurrent central hypogonadism.
Raloxifene decreases serum IGF-I in male patients with active acromegaly.
Raloxifene might be useful in the treatment of male patients with active acromegaly, but longer term studies are clearly needed.
Raloxifene lowers IGF-I levels in acromegalic women.
RAL decreases IGF-I levels in most acromegalic women with mild or intermediate disease and normalizes it in many and a prospective randomized study in patients resistant or partially sensitive to other medical treatments is warranted.
Estrogen and selective estrogen receptor modulators (SERMs) for the treatment of acromegaly: a meta-analysis of published observational studies
It was concluded that estrogen and SERMs are a low cost and effective treatment to achieve control of IGF-1 levels in acromegalic women either as concomitant treatment for refractory disease, or where access to conventional therapy is restricted.
Effects of tamoxifen on GH and IGF-I levels in acromegaly
Tamoxifen (TAM), a non steroid partially competitive antagonist to the estrogen receptors, has been reported to decrease plasma GH and IGF-I levels both in vitro and in vivo, and it is likely that the observed decrease in plasma IGF- I levels is dependent on TAM activity at the hepatic level.
Tamoxifen enhances the control of acromegaly treated with somatostatin analog lanreotide
The case of a 51-year old female patient with acromegaly that was resistant to somatostatin analogs and dopamine agonists and diagnosed with breast cancer requiring treatment with the anti-estrogen tamoxifen is presented.
Modulatory effect of raloxifene and estrogen on the metabolic action of growth hormone in hypopituitary women.
The modulatory effects of E (2) and R at therapeutic doses on GH action are different, and R during GH therapy exerts a greater inhibitory effect on lipid oxidation and protein anabolism compared to E(2).
Tamoxifen reduces serum insulin-like growth factor I (IGF-I)
Recent clinical and laboratory data suggest that the commonly used antiestrogen tamoxifen also acts to reduce serum IGF-I levels, which may contribute to the cytostatic activity of the drug.