Hi all,

	I have permission to post.  I received a call from mother who has a diagnosed microprolactinoma, with a 2 week old, with no other significant health history reported.  She had milk supply issues with her first baby who is now 2 1/2, and stopped BF after 1 week.  This time she wanted to be prepared so she received a lot of lactation support right from the beginning, but apparently still had significant milk supply issues and baby weight gain issues.  Baby's birth weight was 9.8 lbs and at a 1 week he was 8.6 lbs (11.8 % loss).  She also reported that she did feel her mature milk "come in", but soon realized that she was not producing enough for her son.  She was working with another LC until she called me, so I was not involved in the beginning. She called me to see if there was more she could do.  When I spoke with her a week ago ( 2 weeks postpartum) she was still breastfeeding, and pumping only 3-5 times/day b/c that was all she could manage.  She was supplementing mostly formula after every feeding, (which ended up being 2 ounces every feeding) until he was "full" , per pediatrician's rec's. 
	Unfortunately, I could not see her at that time as I was going out of town for the holidays, so I have not observed his latch, or suck/swallow.  Per mom, her son "sucked" for 5-8 minutes on each side, with sucking and swallowing, and a sensation of MER (??). Mom reported that there were no issues with his latch. At that time we discussed Domperidone and/or Reglan, but I let her know that I wasn't sure if it would help in this situation.  Mom was at that time taking Fenugreek (4 capsules/day) and drinking Mother's Milk Tea with only minimal increase in her milk supply, along with the pumping and BF. I let her know that I would do some research and get back to her as soon as possible.  Since I could not see them, I suggested she go back to the LC who had been working with her and her son to try using a supplemental nursing system.  I explained the benefits over bottlefeeding to her (as well as the cons) and left it at that.  
	In the meantime I researched microprolactinoma. including a Lactnet search, but I did not get any clear answers.  I know that there could be something else going on, completely unrelated to the prolactinoma, but nothing in her history yet suggests any other issues (Although she was supplementing quite a bit, and wasn't pumping often, which could be another contributing factor that I don't want to rule out). I was finally able to connect with her today, after a lot of phone tag (so now I have permission to post:).  She is now exclusively bottlefeeding.  She did not want to try a supplemental nursing system or continue BF, as pumping, BF, and bottlefeeding became too time consuming for her.  She is now pumping every 3 hours, is on Reglan, and she yields slightly more that she did before- 1ounce (1/2 ounce each breast) per pumping session.  She feels good about her decision, and feels any breastmilk was/is better than none.  She is giving it another week, at that time, she will return her hospital grade pump.  She was however, still interested in looking at a cause of her low milk supply and if there is something she can do, she would do it.  She has not had any bloodwork done since pregnancy.  I suggested looking at hormone levels, and based on what I have read possibly including the following: prolactin, TSH, T3 and T4, testosterone, estrogen, cortisol (2 hours after BFing?), insulin? progesterone?.
	So, my main questions are: 1) has anyone had a similar situation, and what did you discover 2) What hormones should be checked specifically 3) When checking prolactin levels, when is the optimal time mom's levels should be checked ( i.e. just prior to BF, after?), and 4) anything else??.  Baby is now approx 3 weeks old.

Thanks for any input you have!  Looking forward to hearing what you all have to say :)

Happy Holidays to everyone!

Nina Isaac, MS, CCC-SLP, IBCLC, LLLL
Tucson, AZ
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