case_images: PMC6038655_01
case_images: Timeline of treatment effects on serum IGF-I, growth hormone (GH), testosterone, and free testosterone levels. TSR: transsphenoidal resection. CC: clomiphene citrate.
case_images: CRIE2018-7925019.001.jpg
case_images: PMC6038655_01_CRIE2018-7925019.001.jpg
case_images: fig1
case_images: Serum IGF-I level by immunochemiluminometric assay (ICMA) was increased at 457 ng/mL (reference range 67-205 ng/mL), as well as serum prolactin 79 ng/ml (reference range 4.0-15.2 ng/ml) growth hormone (GH) level 1.9 ng/mL (reference range 0-10 ng/mL) which did not suppress 2 hours after a 75 gram oral glucose load measured at 1.8 ng/mL; while serum testosterone level was markedly decreased at 74 ng/dL (reference range 348-1197ng/dL), gonadotropin levels were normal (Figure 1). Six months after clomiphene initiation, the patient reported resolution of fatigue and improved libido which correlated with an improvement on total testosterone levels 355 ng/dL and free testosterone level 8.6 pg/ml. 11 months after clomiphene therapy, laboratory evaluation reported normalization of both serum IGF-I (134 ng/ml) and a peak serum total testosterone (535ng/dl) and free testosterone (12.6 pg/ml), while GH 0.5 ng/ml and prolactin levels (5.5 ng/ml) remained controlled (Figure 1). Free testosterone levels increased into the normal range with CC treatment, paralleling the increase of total testosterone levels (Figure 1).