Dissanayake Harsha, Keerthisena Sisil, Dematapitiya Chinthana, Katulanda Prasad
Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 7 007, Western province, Sri Lanka.
BMC Endocr Disord. 2014 Dec 17;14:98. doi: 10.1186/1472-6823-14-98.
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'.
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.
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.
溢乳是内分泌学中常见的临床问题。已知来自新生儿的视觉和听觉线索会刺激哺乳期妇女的催乳素分泌。然而，过去尚未报道过因无关新生儿的视觉和听觉刺激导致非哺乳期女性出现高催乳素血症和溢乳的情况。我们报告首例此类“假性泌乳”病例。
一名18岁1型糖尿病女孩出现溢乳症状。显然，在看到婴儿、听到其哭声或回忆起与婴儿相关的事情后就会出现溢乳。她的月经周期正常，未诉任何头痛或视觉障碍。她仅服用二甲双胍和胰岛素。新生儿被转移到其他地方后，症状迅速缓解。检查发现轻压乳头有少量溢液。检查显示血清催乳素升高至62.5 ng/mL（2717.4 pmol/L），空腹血糖为142 mg/dL（7.9 mmol/L），糖化血红蛋白为7.6%。她的甲状腺功能正常，溢乳时未进行MRI检查。3个月时催乳素恢复正常，MRI显示垂体仅有轻微不对称，无微腺瘤证据。
根据临床、生化和影像学证据排除其他病因后，她的症状与对新生儿的情感依恋之间存在强烈的时间关系，提示短暂性高催乳素血症可能是由于新生儿的刺激线索触发了短暂的催乳细胞增生和功能亢进。情绪诱导的“假性泌乳”可能是非哺乳期女性短暂性高催乳素血症的一个罕见但重要的原因。
