Rachel you said, " That's why I asked how low supply could be caused by too
much prolactin.  I still don't understand."
It is my rudimentary understanding understanding that while prolactinomas
may increase overall prolactin levels, there are other factors that could
cause low milk supply, even in the presence of ample prolactin. First off,
the prolactin receptor sites must be functioning well (as with any hormone
in the blood stream, we can measure what is there but we can't really tell
how well the receptor sites are working). Secondly, the pressure of the
prolactinoma on the pituitary (the "master gland")  may decrease other
pituitary hormones that are essential for so many lactation and fertility
related processes. The anterior and posterior portions of the pituitary
secrete various hormones so depending on where the tumor is located various
hormones could be affected. Also, the pituitary is a key player in the HPA
axis, which hugely affects the adrenals, thyroid, etc. So I think it is fair
to say that other, complex factors could certainly lead to low milk supply
even in the presence of high prolactin levels. 


Melissa Cole, IBCLC
Portland, OR/Vancouver, WA

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