>>Re: the prolactin test she took: She pumped at 6:30 am; Blood drawn at
8:15am; She was 16 wks postpartum at the time of the test. She only pumped 4
times per 24 hours.

Her LH/FSH/CBC levels were normal (no numbers given to me) no thyroid levels
drawn - Dr refused.  Yes - she just switched Dr's again.  Her Prolactin
Levels came back at 24.6.  She was told it was within normal.  However, my
Lawrence says that for this time period it should be upward of 50.  

What other information do you need to help this mom figure out what is up?
Could this still be a pituitary tumor possibility?  Why would she be
producing this much milk with such a low level?<<

Jaye,
That's pretty amazing. 24.6ng/mL is the top of the range of normal for
non-lactating, non-pregnant women. Lactating women can drop to that level
over time, but 4mos is pretty early. She definitely is NOT
hyperprolactinemic, and so she does not have a prolactin-secreting tumor,
because her prolactin is not elevated above normal for either lactating or
non-lactating. In fact, part of the reason it is so low probably is the low
frequency of milk removal-- 4x/day. Prolactin levels postpartum are driven
by the surges produced while feeding/pumping; they surge, then the body
slowly clears them out. The more often they surge, the higher "average"
prolactin level; the less often, the lower the level, due to clearance. My
guess is that she either has an unusually high number of prolactin
receptors, or the receptors are hypersensitive, or both.

Hyperthyroidism, postpartum onset, could cause high milk production, but she
would likely have other metabolic symptoms showing increased metabolism such
as jitteriness and losing weight.  It is too bad the physician would not
check thyroid. 

But the other side of the equation is that she is *removing* this amount of
milk on a daily basis. Does she do so for comfort, or because she wants all
that milk? This would certainly reinforce to the breast to keep producing
this amount of milk.

~Lisa Marasco

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