Estrogen and selective estrogen receptor modulator (SERM) treatments for 
acromegaly have received limited attention since the development of newer 
pharmacologic therapies. There has been ongoing research evidence suggesting 
their utility in the biochemical control of acromegaly. Therefore, the aim of 
this meta-analysis was to synthesise current evidence with a view to determining 
to what extent and in which acromegalic patient subsets do estrogen and SERMs 
reduce IGF-1 levels. A literature search was conducted (finished December 2012), 
which included all studies pertaining to estrogen or SERM treatment and IGF-1. 
Seven patient subsets were identified from six published observational studies, 
and were pooled using meta-analytic methods. Overall, the pooled mean loss in 
IGF-1 was -29.09 nmol/L (95 % CI -37.23 to -20.95). A sensitivity analysis 
indicated that women receiving estrogen had a substantially greater reduction in 
IGF-1 levels compared with women receiving SERMs, with a weighted mean loss in 
IGF-1 of -38.12 nmol/L (95 % CI -46.78 to -29.45) compared with -22.91 nmol/L 
(95 % CI -32.73 to -13.09). There was a trend that did not reach statistical 
significance for men receiving SERM treatment at -11.41 nmol/L (95 % CI -30.14 
to 7.31). 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. Their use in men requires further study.