Hi there...I could really do with some hot tips/ideas/information on this case.
I have a client with a prolactinoma- I met her at 4 weeks postpartum last time (she is pregnant again)- she had unilateral mastitis and no obvious milk production- she was very distressed and we were able to resolve the mastitis (although it reoccurred at 5 months) and she artificially fed her baby.
I have worked with mothers with prolactinomas previously- they ranged from profuse lactation, to very-slow-to-come-in  lactation (1 case- 14 days for first babe, 10 for her second and about 5 days for her third baby), and one mother who had some production but needed to give articical milk too.
I have read some and consulted the archives. Any further thoughts or knowledge on this case would be appreciated.
I know that this mother's lactation can be managed more efficiently this time (last time she told me that she expressed minimally using a mini electric pump- but her breasts were very painful- a side effect of the high prolactin I believe).
Anyway here is her history...
Family history of breast cancer (by the way, she is in the care of a breast surgeon and an endocrinologist), infertility created by the high prolactin/prolactinoma.
Required only 1 week of bromocriptine to conceive and then discontinued (same thing for this current pregnancy).
Breasts enlarged 1 cup size (14F), 7 hour labour, vaginal delivery. Doesn't remember any breast fullness a few days into the postpartum.
Prolactin levels approx 1000 mIU/L pre pregnancy; 3 months into pregnancy the prolactin level was recorded as approx 3000 mIU/L......it dropped to 2000+ during the remainder of the pregnancy. 
1 month postpartum it was 1500.....at 3 months pp it was 800. Similar level to this prior to taking bromocriptine again to get pregnant in January (range 40-600 mIU/L).
I was interested in a similar case presented on lactnet by Cynthia Swisher (22 Oct 03).....also a case presented by Sharon Knorr (25 Aug 03)...There was a comment about "sometimes mothers also produce antibodies to the prolactin which can suppress the symptom of galactorrhea"........I would love some more info about this if anyone has ideas/info.
On my client's lab result sheet there is also mention of macroprolactin...a variant in which prolactin is bound to another protein, usually an immunoglobulin. This causes serum levels to be elevated without the associated biological effect (this mum at least had a negative result to macroprolactin). 
Also Diane Wiessinger commented on a case (24 Oct 03)..."prolactin levels remained at a normal level for a non-pregnant woman in this woman's pregnancy.....as prolactin is necessary for lobular-alveolar development..
I know this is very bitsy but I hope some of you can help.
Many thanks in anticipation.
Regards
Trish Warder
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