Recovery of persistent hypogonadism by clomiphene in males with prolactinomas under dopamine agonist treatment

Recovery of persistent hypogonadism by clomiphene in males with prolactinomas under dopamine agonist treatment

Author Ribeiro, Rogerio Silicani Autor UNIFESP Google Scholar
Abucham, Julio Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Context: Persistence of hypogonadism is common in male patients with prolactinomas under dopamine agonist (DA) treatment. Conventional therapy with testosterone causes undesirable fluctuations in serum testosterone levels and inhibition of spermatogenesis.Objective: To evaluate the use of clomiphene as a treatment for persistent hypogonadism in males with prolactinomas.Design: Open label, single-arm. prospective trial.Patients: Fourteen adult hypogonadal males (testosterone <300 ng/dl and low/normal LH) with prolactinomas on DA, including seven with high prolactin (range: 29-1255 mu g/l: median: 101 mu g/l) despite maximal doses of DA.Intervention: Clomiphene (50 mg/day orally) for 12 weeks.Measures: Testosterone estradiol, LH, FSH, and prolactin were measured before and 10 days, 4, 8, and 12 weeks after clomiphene. Erectile function, sperm analysis, body composition and metabolic profiles were evaluated before and after clomiphene.Results: Ten patients (71%), five hyperprolactinemic and two normoprolactinemic, responded to clomiphene (testosterone >300ng/dl). Testosterone levels increased from 201 +/- 22 to 457 +/- 37 ng/dl, 436 +/- 52, and 440 +/- 47 ng/dl at 4, 8, and 12 weeks respectively (0.001<P<0.01). Estradiol increased significantly and peaked at 12 weeks. LH increased from 1.7 +/- 0.4 to 6.2 +/- 2.0 IU/l, 4.5 +/- 0.7. and 4.6 +/- 0.7 IU/l at 4, 8, and 12 weeks respectively (0.001<P<0.05). FSH levels increased in a similar fashion. Prolactin levels remained unchanged. Erectile I, unction improved (P<0.05) and sperm motility increased (P<0.05) in all six patients with asthenospermia before clomiphene.Conclusions: Clomiphene restores normal testosterone levels and improves sperm motility in most male patients with prolactinomas and persistent hypogonadism under DA therapy Recovery of gonadal function by clomiphene is independent of prolactin levels.
Language English
Sponsor Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Date 2009-07-01
Published in European Journal of Endocrinology. Bristol: Bioscientifica Ltd, v. 161, n. 1, p. 163-169, 2009.
ISSN 0804-4643 (Sherpa/Romeo, impact factor)
Publisher Bioscientifica Ltd
Extent 163-169
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000272934700020

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