As Pat Young said, this woman has a known prolactinoma, which is by
definition a prolactin-secreting tumor.  If it is a 'micro' tumor I am
assuming, possibly wrongly, that its size is small and is unlikely to
be crowding out anything else.  So the only pituitary hormone I would
expect to be abnormal is prolactin, and I would expect it to be high,
unless she has been treated for the prolactinoma with something that
is toxic to the prolactin-secreting cells.   But mostly I am puzzled
because the clinical picture is not in accordance with what I would
expect to see.   And I agree with Pat, it is the endocrinologist who
presumably is following her for the prolactinoma who should be
considering what tests to run, in collaboration with her primary care
doctor if she lives somewhere where primary care docs are the norm.

Bromocriptine was used right up until about 10 years ago for
suppression of lactation and is still available for that use where I
live, but if we have cause to stop lactation pre-emptively in the
hospital now, we use cabergoline (Dostinex is the brand name here,
don't know about the US).  Doesn't happen much.  I'm well acquainted
with the side effects and deaths from bromocriptine use.

In my own practice in the hospital I've discovered two cases of
diabetes insipidus which presented as primary lactation failure, when
nobody else was thinking pituitary issues at all.   I learned a lot
about pituitary hormones beyond the basic knowledge I already had as a
midwife and later as an IBCLC.   That's why I asked how low supply
could be caused by too much prolactin.  I still don't understand.

I would be interested to know about this particular woman's treatment
history, if it is possible.  It might be edifying for the list to find
out more, since we are already discussing her in detail.

Rachel Myr
Kristiansand, Norway

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