It seems that her galactorrhoea was STRESS-RELATED. Stress increases endogenous intracerebral opioid secretion, that inhibits dopamin and consequently increases PRL. But her PRL is normal. The explanation may be 1) it might not have done at time of menstruation when she is having more secretion. 2) More likely explanation is that, PRL is secreted in episodic bursts. Sometimes, transient but very high level of PRL can sensitize the breast tissue to PRL and estrogen and as a consequence even when PRL level comes down to normal, the breast tissue secretion continues and galatorrhoes is seen. She is having milk expression from multiple openings and menstrual engorgement, so local breast pathology is highly unlikely. Breast engoregement during mens may be a part of premenstrual syndrome (as she is still menstruating, so assumed to have enough progesterone and preogesterone causes engorgement)... At the same time, we need to exclude common causes of hyperprolactinemia (though her PRL is normal) like pharamacological (particularly dopamine antagonists like metoclopramide, domperidone- often consumed as OTC) and also TSH. I would have skipped CT because her PRL is normal and if there is no CNS features (optic field defect, headache etc)... Only with PRL >100 and/or CNS symptoms, I would consider MRI (as CT images pituitary fossa poorly)... I would advise her cabergoline 0.25 mg twice weekly initially and then adjusting accordingly and maintenance of local hygiene (including avoidance of repeated milk expression by herself or even during coitus)
It seems that her galactorrhoea was STRESS-RELATED. Stress increases endogenous intracerebral opioid secretion, that inhibits dopamin and consequently increases PRL. But her PRL is normal. The explanation may be 1) it might not have done at time of menstruation when she is having more secretion. 2) More likely explanation is that, PRL is secreted in episodic bursts. Sometimes, transient but very high level of PRL can sensitize the breast tissue to PRL and estrogen and as a consequence even when PRL level comes down to normal, the breast tissue secretion continues and galatorrhoes is seen. She is having milk expression from multiple openings and menstrual engorgement, so local breast pathology is highly unlikely. Breast engoregement during mens may be a part of premenstrual syndrome (as she is still menstruating, so assumed to have enough progesterone and preogesterone causes engorgement)... At the same time, we need to exclude common causes of hyperprolactinemia (though her PRL is normal) like pharamacological (particularly dopamine antagonists like metoclopramide, domperidone- often consumed as OTC) and also TSH. I would have skipped CT because her PRL is normal and if there is no CNS features (optic field defect, headache etc)... Only with PRL >100 and/or CNS symptoms, I would consider MRI (as CT images pituitary fossa poorly)... I would advise her cabergoline 0.25 mg twice weekly initially and then adjusting accordingly and maintenance of local hygiene (including avoidance of repeated milk expression by herself or even during coitus)
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