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Subject:
From:
Lisa Marasco IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 19 Jan 2001 18:46:41 -0800
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Marsha,
I suspect that it's congenital adrenal hyperplasia (CAH) rather than
"chronic". I don't know a lot about it directly; what I do know is derived
from my research on PCOS, as CAH is part of the differential diagnosis.

Given that this is a congenital condition, and that excess testosterone is a
problem, I would concur with your suspicions as well as those of Denny's,
that there is room for interference with lactation. The first level would be
with breast gland growth during puberty, and the second level would be
pregnancy/lactation. Testosterone is known to inhibit lactation...... my
understanding is that it down-regulates prolactin and estrogen receptors.

I just did a quick search under CAH and lactation that resulted in three
citations from '71 and '69, but no abstracts available. A search under CAH
and breast had a lot more hits, including the following that mentions breast
development problems........

Hormonal and genetic analysis of a patient with congenital adrenal
hyperplasia.
AUTHORS:  Summers RH; Herold DA; Seely BL
SOURCE:  Clin Chem 1996 Sep;42(9):1483-7

ABSTRACT:  We describe a patient with signs and symptoms of virilization
caused by 21-hydroxylase deficiency. The patient, a Hispanic woman, first
sought medical attention at age 24, when she presented to a medical clinic
with an uncomplicated urinary tract infection. At that time several signs of
virilization were noted and she was referred to the endocrinology clinic.
Evaluation revealed temporal balding, hyperpigmentation, acne, absent breast
development, a muscular habitus, and clitoromegaly. Radiological studies
revealed bilaterally enlarged adrenal glands and ovaries. Laboratory
evaluation revealed markedly increased concentrations of
17-hydroxyprogesterone, androstenedione, and testosterone. The patient was
diagnosed with congenital adrenal hyperplasia (CAH) and received hormone
therapy.

Here is another intriguing one:

Rapid occurrence of thelarche and menarche induced by hydrocortisone in a
teenage girl with previously untreated congenital adrenal hyperplasia.
AUTHORS:  Schwarz HP; Jocham A; Kuhnle U
SOURCE:  Eur J Pediatr 1995 Aug;154(8):617-20

ABSTRACT:  A 14-year-old girl with untreated simple virilizing congenital
adrenal hyperplasia presented with absent breast development. She had not
had menarche. During treatment with hydrocortisone, breasts progressed from
Tanner stage one to three within 6 months and menarche occurred after 10
months. However, a 1.5 cm pituitary adenoma, later described as unspecific
pituitary enlargement, remained unchanged. CONCLUSION: In a female with
untreated congenital adrenal hyperplasia and an adult bone age, signs of
puberty appeared very rapidly once appropriate treatment had begun. This was
supposedly due to the declining androgen secretion from the adrenals and the
release of their restraining action on the hypothalamic-pituitary ovarian
axis.

One more:

A comparative study of the effect of oestrogen substitution therapy on
breast development in girls with hypo- and hypergonadotrophic hypogonadism.
AUTHORS:  Pertzelan A; Yalon L; Kauli R; Laron Z
SOURCE:  Clin Endocrinol (Oxf) 1982 Apr;16(4):359-68

ABSTRACT:  During treatment of girls with oestrogen deficiency we observed
different patterns of breast development in response to therapy. The
forty-five girls studied fell into four groups: Group A, gonadal dysgenesis;
Group B, isolated gonadotrophin deficiency; Group C, multiple pituitary
hormone deficiencies; Group D, congenital adrenal hyperplasia
(17-alpha-hydroxylase deficiency). Treatment with oestrogen was given in an
identical manner to all. In the patients with gonadal dysgenesis, in whom
the hypothalamic-pituitary function was normal, treatment led to full breast
development. In isolated gonadotrophin deficiency and multiple pituitary
hormone deficiency breast development was incomplete even after 3 years or
more of oestrogen treatment. The conspicuous difference in the hormonal
status is that the latter two groups lack gonadotrophins, while in gonadal d
ysgenesis these hormones are grossly elevated. Our conclusion is that
gonadotrophins play an important role in mammary gland development, a
finding not previously described. In the girl with 17-alpha-hydroxylase
deficiency we observed that cortisol was necessary, in addition to sex
hormones, for normal breast development.

Hope this helps--
Lisa Marasco IBCLC

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