Prolactin

 1-10-19:-

A woman cones to OPD with the solo C/O of Galactorrhoea at the age of 31 yrs, mother of one child 9 yrs. No  H/O headache , eye disorders .Denies ingestion of any drugs for acid peptic disorders / drugs for  mood elevators, or ocps  intake. How to proceed? Ans:- Point 1:- Stop writing the word   Galactorrhoea in your prescription Point 1:-The correct terminology for Galactorrhoea now is “inappropriate lactation”.   Point 2: Examine the breasts clinically:-In such cases with inappropriate lactation local examination of Breasts is warranted for any duct pailloma & if necessary one should not hesitant to go for breast sonography. Point 3:-It is a wise policy to check PRL by repeating  such hormone in a good Lab and estimate dif fractions of PRL-bio active PRL (monomers) in particular by gel ppt method as I have repeatedly mentioned and as is suggested in all endocrinology books ( i.e. adding poly ethylene glycol  in the sample ) . may talk to your endocrinologist  friend which Lab does this test as copybook fashion. Point 4: Microscopic examination of secretions from Breast .All abnormal mammary secretions including this case, whatever may be the colour, viscosity of  the secretions from breast must be examined by light microscopy for fat droplets which is easily demonstrable by simple  stain. : - Point 5 :- Complaint A:-Is subfertility is an issue for this  woman showing inappropriate  lactation or else Complaint B Oligomenorrhoea? Ans.-If oligomeno is her chief concern and there is Lab evidence of  normo-prolactinoma insist on thyroid profile  & better be hesitant to treat her by dopamine agonists (like broom/Cabergolin) initially . The Oligomeno at the age of > 30 yrs may be unrelated to causes which has lead to  Galactorrhoea. Point 6  :-  But if subfertility is an issue then in spite of normal serum PRL  one can must seriously consider   prescribing  dopamine agonist particularly if ET is thin which favors  possible hypoestronism- induced thin ET. If PRL level exceeds> 100 MRI of ant  Pituitary  is must as imp is referral to endocrinologist & Neurosurgeon . Point 7:-  Additionally we must remember that , PRL itself can  adversely affect growth ET. Point 8:-Is she taking acid peptic Inhibitors  or mood elevators which may inhibit PIF at hypothalamus and cause rise of PRL. May enquire about eye problems & headache and vomiting, May consult ophthalmologist & neurologist but it is unlikely there will be any such abnormality with so little rise of PRL.  Point 8:- No MRI before PRL is > 100 .MRI is better than CT.