Jane Moody posts about a woman who has become preg. after undergoing removal
of pituitary tumor.  I saw a woman about a year ago -- an older primip (40
if I recall correctly) who very much wanted to breastfeed.  She came to see
me about a week pp when she discovered at 1st pedi. visit that baby was down
about a lb from birthweight.  I took a thorough health hx and the only thing
that jumped out at me was she had had a pituitary tumor removed 6 yrs
previously.  She had normal prolactin levels since the surgery, and the
surgeon had told her that the pituitary had not suffered much damage during
the proceedure.  She had flacid breasts when I saw her, no signs of
engorgement pp or even after we began a course of vigorous stim. with a
breast pump.  Baby was, by then, pretty frustrated at breast due to lack of
milk reward.  We used a feeding tube device trying to maintain baby's
interest.  This plan was followed for about 10 days, with absolutely no
response in terms of increased milk production.  My only explanation was
that there must have been more damage to the pituitary than anyone thought.
While her pituitary was able to secrete "normal" levels, it did not seem
capable of increasing those levels.  My reading of the physiology of
lactation suggests that once established, prolactin doesn't have to stay
high, although it looks as though there may always be a small surge with
sucking, but levels are high immed. pp, and this seems to have been
something which didn't occur with this mother.  There was no evidence of
retained placenta, or hx of diabetes, thyroiditis, etc.  Not being an
endocrinologist, I could not give her an opinion on whether taking a
prolactin enhancing drug would be safe for someone with her medical hx.  I
referred her back to her endocrinologist, who seemed completly disinterested
in breastfeeding and basically told her to wean to formula.  I would
hesitate to generalize from one case, but I did want to share the story.
Barbara