In my limited clinical experience (I am an internist specializing in breast
disease), I have never heard of the clinical use of supplemental
prolactin.  I have read a study (not in humans, but in rodents, I think) in
which human recombinant prolactin was used to boost lactation).  I do not
believe that recombinant prolactin is available for use in humans at this
time.

Has anyone considered trying metoclopramide?  It is doubtful that it would
work given her extremely low levels of prolactin, but this can also serve
as a means of further diagnosing her condition as it serves as sort of a
stimulation test for the production of prolactin.

In response to your question about PCOS, I feel compelled to mention that
this mom's history brings to mind two conditions which should be
considered.  I'm glad to see that she has an upcoming appointment with an
endocrinologist who should be able to look into these further.

First, chronically low prolactin levels in and of themselves (whatever
their cause) can cause menstrual irregularities and problems with
fertility.  Hence her difficulty conceiving may have been due to low
prolactin levels all along.

Second, there is a group of rare conditions (some with autoimmune
etiologies and some which are due to inherited gene defects) in which the
patient presents with "polyglandular failure" (the dysfunction of multiple
endocrine organs.

In this mom's case, her thyroid problem and what sounds like a possible
partial ovarian failure along with the low prolactin (from her pituitary
gland) may all be a result of such a syndrome.  There are many other organs
which may be affected including the adrenal glands which produce cortisol
and the pancreas which produces insulin.  The fact that she has a normal
random cortisol level does not rule out problems with her adrenal gland- a
special stimulation test would be necessary to rule out problems with the
adrenal.)

Finally, you did mention that there was no evidence of a post-partum
hemorrhage.  However, I would hope that the endocrinologist would also want
to firmly rule out the possibilty that she has Sheehan syndrome from birth
related pituitary necrosis.

I'm sorry that I am not aware of any treatments available to supplement her
prolactin level at this point (and I apologize if this post has become too
medically wordy!)

Jayne Charlamb, MD
Breast Care Center
Syracuse, NY

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