Emotionally induced galactorrhoea in a non-lactating female--"Pseudo- Lactation"?

BACKGROUND: Galactorrhoea is a common clinical problem in endocrinology. Visual and auditory cues from the newborn are known to stimulate prolactin secretion in lactating women. However, hyperprolactinaemia and galactorrhoea in a non-lactating female due to visual and auditory stimuli from an unrelated newborn has not been reported in the past. We report the first such case of 'pseudo-lactation'. CASE PRESENTATION: An 18-year-old girl with type 1 diabetes mellitus presented with galactorrhoea. Apparently galactorrhoea was preceded by seeing the baby, hearing her cries or when remembering her memories. Her menstrual cycles were normal and did not complain of any headache or visual disturbances. She was only on metformin and insulin. Symptoms have rapidly resolved after the newborn was shifted to another location. Examination revealed scanty nipple discharge with gentle pressure. Investigations revealed an elevated serum prolactin of 62.5 ng/mL (2717.4 pmol/L) and fasting plasma glucose of 142 mg/dL (7.9 mmol/L) and HbA1c of 7.6%. Her thyroid function was normal and MRI at the time of galactorrhoea was not available. At 3 months prolactin was normal and MRI revealed only a slight asymmetry of the pituitary without evidence of microadenoma. CONCLUSION: The strong temporal relationship between her symptoms and emotional attachment to the newborn with exclusion of other causes on clinical, biochemical and radiological evidence, raise the possibility that transient hyperprolactinaemia was due to a transient lactotroph hyperplasia and hyper function which had been triggered by the stimulatory cues from the newborn.Emotionally induced "pseudo lactation" may be a rare but important cause for transient hyperprolactinaemia in a non-lactating female.

Reliability and validity of a new sexual function questionnaire (Nagoya Sexual Function Questionnaire) for schizophrenic patients taking antipsychotics.

OBJECTIVE: This study aims to validate a new user-friendly sexual function questionnaire (Nagoya Sexual Function Questionnaire [NSFQ]) for schizophrenic patients taking antipsychotics. METHODS: Schizophrenic outpatients (men = 30, women = 30) were asked to fill out the NSFQ at initial entry into the research program (Time1) and again 1 to 2 weeks later (Time2). To assess the convergent validity of the NSFQ, at Time1, subjects were asked to fill out the Japanese version of the Udvalg for Kliniske Undersogekser Side Effect Rating Scale (UKU). To assess the discriminant validity of the NSFQ, at Time1, subjects were also asked to fill out the Japanese version of Epworth Sleepiness Scale. RESULTS: Results from Cronbach's alpha analysis indicated that the NSFQ demonstrated excellent internal consistency and scale reliability. The NSFQ also demonstrated strong test-retest reliability. The NSFQ total score was highly correlated with the UKU total score. The NSFQ was shown to have good convergent validity with the UKU. The NSFQ total score was not correlated with the Japanese version of Epworth Sleepiness Scale total score. CONCLUSIONS: This study revealed the internal consistency, test-retest reliability, and convergent and discriminant validities of the NSFQ.

Hyperprolactinaemia with amisulpride.

Psychopharmaca are used in treatment of psychiatric illnesses and disorders, among other therapeutic possibilities. The choice of the psychopharmaca is determined by the specific psychopathology of the patient, within the diagnostic categories, according to the current classification of diseases and disorders. With the advances in pharmaco industry, the range of drugs used in the everyday clinical practice is occurring at a very rapid pace. Antipsychotic medications are used in treatment of mainly psychotic disorders. However, the new generation of antipsychotics, due to their specific receptor affinities, is sometimes used in treatment of affective disorders as well. We are reporting a case of a female patient who was hospitalized several times. Amisulpride was introduced in the treatment and due to a series of unfortunate events and changes that followed (i. e. frequent hospitalizations and changes of therapists, different mental institutions) dose of amisulpride was gradually increased to its antipsychotic doses, which did not help achieve therapeutic benefits, but serious side effects.

Galactorrhea and amenorrhea in burn patients.

INTRODUCTION: Galactorrhea and/or amenorrhea, although uncommonly reported in post-burn patients, is a complex problem to treat. Patient is reluctant to volunteer history of these symptoms, unless asked specifically. AIM: To study profile of adult female patients with galactorrhea and/or amenorrhea in post burn period. MATERIALS AND METHOD: A prospective study of all adult female patients presenting with or detected to have galactorrhea and/or amenorrhea in post burn period was conducted over 6 month's period. Detailed clinical examination, estimation of LH, FSH, Prolactin levels and X-ray of skull was done in all patients. The data collected was analyzed. Patients with hyperprolactinemia and galactorrhea were treated with Bromocriptine for 3 weeks to 3 months. In all patients with amenorrhea, pregnancy was ruled out by gynecological examination and urine pregnancy test. RESULTS: During this period, 30 patients (15.15%) were detected to have galactorrhea and/or amenorrhoea. The extent of burn in these patients was 20-65%of body surface area. Out of 30 patients, 5 had galactorrhea and amenorrhea, 1 galactorrhea alone and 24 had amenorrhea alone. Analysis of voluntary disclosures and detection on interrogation was done. Till the end of study, 4 patients with galactorrhea had complete relief, 2 patients reported reduction in discharge. DISCUSSION: Galactorrhea was distressing for all and was always associated with high prolactine levels .The reverse was not true. All the patients had chest burns besides other body areas. Association was noted between menstrual aberration and ovulatory phase at the time of burn. CONCLUSION: Galactorrhea and menstrual disturbances do exist in female patients in reproductive age group in post burn period and patients should be especially interrogated for these symptoms by the burn care providers.

Good clinical history scores over extensive workup in unmasking a case of galactorrhoea.

The clinical presentation of a young woman with galactorrhoea is described in detail including the history and clinical examination findings. While the patient and her family members feared a serious medical condition which had so far been an obscurity despite a number of investigations, we tried to diagnose the patient starting from the basics, which after a proper history revealed a levosulpiride-induced galactorrhoea. This again lays emphasis on the old adage in medical field that 'a proper history and examination are the key to diagnosis'. There are few reports pertaining to levosulpiride-induced galactorrhoea making it a rare side effect of this drug. We further try to discuss the different causes of galactorrhoea in a young non-pregnant woman which can be encountered in clinical practice.

An Adoptive Mother Who Became a Human Milk Donor.

Inducing lactation in the absence of pregnancy (nonpuerperal lactation) is not always successful and, in many cases, only partial breastfeeding is achieved. Different protocols have been described, but scientific evidence and research are lacking in this area. The authors describe the case of a woman with a history of a miscarriage, for whom the lactation induction process was so effective that she became a milk donor even before she received her adopted child. She had not previously used hormone treatment. She was given domperidone as a galactogogue for 1 month. The pumping protocol began with a double electric breast pump combined with manual pumping 6 months before her child was delivered, and 3 months later, she was accepted as a donor by our milk bank. This highlights the importance of regular stimulation as a milk production mechanism. This is the first case of human milk donation in an adoptive mother described in the literature.

Psychosocial aspects of hyperprolactinemia.

Fourteen mildly hyperprolactinemic women and 14 matched controls were compared with respect to biographical data, self-reported emotional and somatic well-being, and cortisol production. The patients had significantly more often experienced a separation from their parents in childhood. No differences were found for cortisol levels and emotional and somatic well-being. Future studies also should focus on personality, coping, and defense mechanisms in order to explain these contrasting findings.

Psychosomatic factors in patients with hyperprolactinemia and/or galactorrhea.

A biographic and clinical investigation of 101 patients with hyperprolactinemia and/or galactorrhea is reported. Fifty-one patients were reared without their fathers and 18 with an alcoholic, violent one. These situations were uncommon in the control population, and the differences were statistically significant. There was a high frequency of complaints of obesity, headaches, frigidity, lightheadedness, and fullness of the abdomen, limbs, or face. There was a significant temporal correlation of external events in the natural history with onset or worsening of the symptoms. It is concluded that exposure during childhood to an environment characterized by an absent or alcoholic, violent father conditions some women to develop hyperprolactinemia and/or galactorrhea later in life as a response to specific environmental changes. These conclusions apply similarly to patients with prolactinoma, idiopathic hyperprolactinemia, and euprolactinemic galactorrhea, suggesting a close relationship among the 3 entities.

Endocrinologic and psychologic aspects of galactorrhea associated with normal menstrual cycles.

Twelve cases of galactorrhea in women with normal menstrual cycles who were radiologically free of any pituitary adenomas were investigated. Determinations were made for serum thyroid-stimulating hormone (TSH), T3 resin uptake (T3RU), total thyroxine by radioimmunoassay (T4), free thyroxine index (FT4I), norepinephrine, epinephrine, prolactin and urinary luteinizing hormone, total estrogens, pregnanediol and total catecholamines. Psychologic evaluation and assessment were also done using the Middlesex Hospital Questionnaire and the Eysenk, manual dexterity, Bender Gestalt and trial-making scales. Hypothyroidism associated with moderate hyperprolactinemia and anovulation were the main features in eight cases. Associated psychologic disturbances were reported. The other four cases showed significant elevations in serum epinephrine, norepinephrine and urinary total catecholamines with concomitant pathologic scales of anxiety and neuroticism. Thyroxine replacement and psychotherapy are recommended in the treatment of such cases.

A case of hysteria, with a note on biology.

Psychoanalysis recently has shown interest in the data of neurobiology. This interest has been fostered by the realization that a model of Cartesian mind-body dualism is inadequate to current observation and knowledge. Despite the theoretical appeal of integrating knowledge from the two fields, there have been few attempts at correlation in specific clinical situations. This paper presents a case of hysteria in which the physical manifestations of hyperprolactinemia, galactorrhea, amenorrhea, and infertility are considered in relation to both the brain regulation of prolactin and to unconscious fantasy, motivation, and conflict. Some of the intriguing possibilities and limitations of research at the frontier of psychoanalysis and neurophysiology are discussed.

Childhood's enuresis in the history of women with hyperprolactinemic amenorrhea.

Hyperprolactinemia, or elevated levels of prolactin in blood, is a normal physiologic post-partum response in lactating women. Non-lactating women with hyperprolactinemia often present during the reproductive years since they may have amenorrhea, galactorrhea, or both. Hypersecretion of prolactin is most commonly due to pituitary adenomas. Women with hyperprolactinemic amenorrhea are often quite anxious, depressed and hostile. It has been hypothesized that these psychological symptoms might antecede the onset of hyperprolactinemia and that hyperprolactinemia may be associated with early developmental problems and may be psychogenic in origin. Twenty patients with hyperprolactinemic amenorrhea and twenty-one normoprolactinemic patients with amenorrhea had an interview covering psychiatric history in order to establish whether they had ever met DSM-III criteria for functional nocturnal enuresis at one time during their childhood. While seven out of twenty (35%) patients with hyperprolactinemic amenorrhea were found to have had functional enuresis during their childhood, only two out of twenty-one (9.5%) normoprolactinemic amenorrheic women reported having had functional enuresis. The difference between the two groups was statistically significant (chi-squared: 3.88; p less than 0.05). We postulate that early stress and developmental problems may present in children as psychological distress and functional enuresis and in women as psychological symptoms (e.g., anxiety and depression) and hyperprolactinemic amenorrhea.

Depression hostility and anxiety in hyperprolactinemic amenorrhea.

In order to evaluate the relationship of psychological distress to hyperprolactinemia, 20 patients with secondary amenorrhea were evaluated by a semi-structured research interview and administered the Kellner Symptom Questionnaire. Group A (10 patients with amenorrhea and hyperprolactinemia) reported significantly more symptoms of depression, hostility and anxiety than group B (10 patients with amenorrhea and normal basal levels of plasma prolactin). Both groups were significantly more anxious, depressed and reported more somatic symptoms than a normal control group (n = 10). 6 of the 10 patients in group A reported decrease in libido, while this was found only in 1 of the 10 patients of group B. The findings suggest that the syndrome of depression, hostility and anxiety in a woman complaining of amenorrhea, especially if associated with decreased libido and galactorrhea, can be a manifestation of hyperprolactinemia.

Psychosomatic aspects of galactorrhea.

We interviewed 33 women with non-puerperal galactorrhea, 5 (15%) of whom had HPRL levels greater than 18 ng/ml and 24 controls, namely women with benign breast lesions. We used a semi-structured interview covering the duration of symptoms, preceding life events and the effect on the relationship of the couple. We also used the Beck depression inventory, the Strauss and Appelt body image questionnaire and an 8 item Visual Analogue Scale (VAS). Galactorrheic women were more depressive (P less than 0.1), had more prior life events (P less than 0.001), longer duration of symptoms (P less than 0.01), and less fear of their disease (P less than 0.05) than did controls. Both groups had similar results with the body image questionnaire. Within the study group, results were independent of prolactin (HPRL) levels or amenorrhea.

Galactorrhea: subjective response by schizophrenic patients.

The frequency of galactorrhea and the subjective response to it were investigated in 150 schizophrenic patients. The incidence rate was 14% and the prevalence rate 19%. More than half the women experienced galactorrhea in connection with their femininity, with this side effect of neuroleptic therapy being rated more often as a positive effect, especially as a reinforcement of feminine identity or as an expression of the ability to conceive children. The overall response to galactorrhea was positive among 43% and negative among 20%, with the remaining patients tending towards indifference.

Un caso de galactorrea psicógena sin hiperprolactinemia o síndrome de Nunes / Psychogenic galactorrhea without hyperprolactinemia or Nune's syndrome

Diversos estudios han evidenciado la existencia de factores psicológicos que juegan un papel clave en muchos casos de mujeres que padecen hiperprolactinemia, galactorrea o incluso prolactinoma (fenómeno conocido como síndrome de Nunes). Se han descrito vivencias infantiles que generan tales desórdenes somáticos: separación o ausencia del padre, o padre alcohólico y/o violento que favorecen una regresión infantil donde madre e hija recuperan una relación simbiótica maligna, simbolizada en la lactancia. La paciente aquí descrita presenta una galactorrea euprolactinémica, coincidente con el parto y lactancia de una amiga (AU)