-IBIS-1.5.0-
tx
reproductive system
lactation: excess/deficiency
diagnoses

definition and etiology

definition:
Too much or too little milk production especially during nursing.

etiology:
lactation deficiency: Often due to a deficiency in prolactin. After birth, a prolactin deficiency may be the first indications of panhypopituitarism from pituitary destruction during the peripartum period (that is, Sheehan's syndrome). Prolactin stimulation tests are needed to discern if the prolactin levels are indeed low. Another cause of low lactation includes stopping breast-feeding for a time (due to mastitis, for example).

lactation excess (galactorrhea): Breast secretion as a nonpuerperal or inappropriate phenomenon. However, the precise definition of the illness is not clearly defined in the literature. One quarter of women who have previously given birth can demonstrate lactation to some degree; this appears to be clinically unimportant. The secretion should be checked to ensure that it is milk and not another secretion that may signal serious breast pathology. Unfortunately there is no sure connection between hyperprolactinemia and galactorrhea; in many patients with high prolactin levels, lactation may not occur. And in patients with galactorrhea, the levels of prolactin may be low (for example, in the wet-nurse phenomenon where repeated stimulation of the breasts in a women who has been previously pregnant will cause lactation without a surge in prolactin levels). However, the drug bromocriptine, which causes prolactin levels to be suppressed, decreases galactorrhea (even in women who have low prolactin levels to begin with), so there must be some relationship to the ailment and the hormone, although at this time it is unclear.

signs and symptoms

deficiency: The woman has just given birth:
• No or insufficient amounts of milk are produced.
• Other possible hormonal signs indicating Sheehan's syndrome.

excess: The woman is postpartal or is non-puerperal:
• Secretion of milk beyond the infant's demand.
• Secretion of milk when the woman has not given birth.

lab findings:
• Check prolactin levels.
• Check other pituitary levels if Sheehan's syndrome is suspected.
• (-) inflammatory or cancerous secretion in galactorrhea.

course and prognosis

The course depends on the diagnosis of the true cause of the symptom. Sheehan's syndrome can be serious and necessitate the replacement of all pituitary hormones. The possibility of breast tumor as a cause in the nonpuerperal female secretion of breast fluid must be considered.

differential diagnosis

• Sheehan's syndrome.
• Breast tumor.
• Hyperprolactinemia.
• Hypoprolactinemia.


footnotes