Methods and Success Factors of Induced Lactation: A Scoping Review.

BACKGROUND: Induced lactation enables a woman who has not given birth to breastfeed a child. Lactation may be induced through both pharmacological and non-pharmacological methods, although the desired outcome cannot always be achieved. RESEARCH AIMS: The aims of this scoping review was to assess the different methods used to induce lactation, as well as the factors related to sucking the breast effectively and the production of human milk. METHODS: We searched five databases from June 2019-February 2020 for studies referring to methods and factors related to breast suckling and/or the volume of milk produced after inducing lactation, using the following search terms and Boolean operators: breastfeeding AND induced lactation AND adoptive mothers OR surrogate mothers OR female homosexuality OR non-gestating. The final review included a total of 24 articles. RESULTS: Pharmacological methods were not always used to produce milk, although breast stimulation was essential. The age of the child, interference due to bottle feeding, breast stimulation, and the support received were important factors in the induction of lactation. There were several factors that may account for the differences between developing and higher income countries in methods of induced lactation and the amount of milk that study participants produced. There was no consensus over whether previous pregnancy and/or breastfeeding experience influenced induced lactation. CONCLUSION: Health professionals need to have adequate knowledge about induction methods, the preferences of each woman, and the reasons for inducing lactation, to provide proper assistance. However, the lack of standardization about induction of lactation makes it difficult.

Adolescent amb amenorrea secundària i galactorrea / Adolescent with secondary amenorrhea and galactorrhea

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Macroprolactinemia in women with hyperprolactinemia: a 10-year follow-up.

OBJECTIVES: To determine the frequency of macroprolactinemia in a cohort of hyperprolactinemic women, describing 1) the association of macroprolactinemia with clinical variables and morphological changes in the pituitary gland and 2) clinical status and prolactin levels after 10 years of follow-up. DESIGN: Blood samples were obtained from 32 patients for hormonal assessment. Treatment with cabergoline or bromocriptine was interrupted 3 months before the determination of serum prolactin and macroprolactin. Macroprolactin was measured using the polyethylene glycol (PEG) precipitation method. Computed tomography was performed in all patients. RESULTS: The frequency of macroprolactinemia was 28.1%. In 19 patients prolactin remained elevated (persistent hyperprolactinemia). In 13, prolactin returned to normal (former hyperprolactinemia). Nine patients with PEG recovery between 40 and 50%, and the only two macroprolactinemic patients with previous hyperprolactinemia were excluded from the analysis of clinical outcomes. Only one of seven macroprolactinemic patients had an abnormal pituitary image (empty sella). None had galactorrhea. MAIN FINDINGS: Classic symptoms of hyperprolactinemia and abnormal imaging findings are not common in patients in whom macroprolactin is the predominant form of PRL. CONCLUSIONS: Women with hyperprolactinemia, especially if asymptomatic, should be routinely screened for macroprolactinemia. Macroprolactinemia remains stable in the long term.

Clinical and radiological findings in macroprolactinemia.

Hyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8 ± 10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0 ± 10.1 vs. 30.7 ± 9.8, P = 0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 ± 347.0 vs. 238.8 ± 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels.

Galactorrhea with metoclopramide use in the neonatal unit.

We report a 3(1/2)-month-old infant with trisomy 21 presenting with galactorrhea in the neonatal intensive care unit (NICU). Endocrine work-up showed a high prolactin level (64.4 ng ml(-1)--normal: 0.5 to 30 ng ml(-1)). Cessation of therapy with metoclopramide (0.2 mg kg(-1) per dose q 6 h) resulted in the resolution of galactorrhea with a decrease in serum prolactin level (20.1 ng ml(-1)). We present this case to highlight this uncommon side effect of a commonly used medication in the NICU.

Secreción por el pezón / Secretion by the nipple

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Clinical and etiological profile of hyperprolactinemia--data from a tertiary care centre.

OBJECTIVE: To study the clinical presentation and etiology of hyperprolactinemia, a common disorder encountered in endocrine practice. METHODS: We analyzed the clinical data, hormone profile and imaging reports of 187 females with documented hyperprolactinemia, over a period of 6 years (5 years retrospective analysis and one year prospective study). RESULTS: Majority of the 187 subjects studied presented in 3rd or 4th decade. Galactorrhoea was the commonest presenting symptom occurring in 159 subjects (85%), followed by amenorrhea in 68.9%; both amenorrhea and galactorrhea were seen in 45.4%. A microprolactinoma was demonstrated in 67 patients (35.8%), a nonfunctioning pituitary macroadenoma with stalk hyperprolactinemia occurred in 30 patients (16%) and polycystic ovarian disease was documented in 24 (12.8%). In 52 patients (27.8%) no apparent cause could be ascertained. CONCLUSIONS: Syndrome of amenorrhea and/or galactorrhea is the commonest presentation in hyperprolactinemia. Microprolactinoma was the most frequent identifiable etiology followed by idiopathic and stalk hyperprolactinemia in our series.

"Dopamine-dependent" side effects of selective serotonin reuptake inhibitors: a clinical review.

OBJECTIVE: Neurophysiologic findings indicate an inhibition of dopaminergic neurotransmission by selective serotonin reuptake inhibitors (SSRIs). This article highlights the relationships between changes in dopaminergic neurotrans-mission induced by SSRIs and the occurrence of certain side effects such as hyperprolactinemia, extrapyramidal symptoms, sexual and cognitive dysfunction, galactorrhea, mammary hypertrophy, and, more rarely, gynecomastia. DATA SOURCES AND SELECTION: A systematic search of the literature in English, French, and German from 1980 to 2004 was performed in MEDLINE, EMBASE, and the Cochrane Library using the keywords SSRI, dopamine, serotonin, side effects, antidepressants, citalopram, escitalopram, sertraline, paroxetine, fluoxetine, fluvoxamine, and nefazodone. References cited in all trials were searched iteratively to identify missing studies. All studies concerning inhibition of dopaminergic neurotransmission by SSRIs and SSRI-related side effects were considered. We retained 62 significant articles debating the subject. DATA EXTRACTION AND SYNTHESIS: We critically reviewed the studies, depending on the methodologies (case reports, clinical reports, randomized studies), and assessed the pertinence of "dopamine-dependent" SSRI-related side effects. The analytic review of these articles suggests that some specific SSRI-related side effects be classified as dopamine-dependent. CONCLUSIONS: At a clinical level, it could be useful to underline dopamine-dependent characteristics of some SSRI-related side effects. This approach would allow clinicians the opportunity to search other dopamine-dependent side effects systematically. At a pharmacologic level, this approach could stimulate the development of molecules with a "corrective" function on dopamine-dependent side effects of SSRIs by facilitating dopaminergic neurotransmission.

[Interest in prolactin levels in galactorrhea]. / Interet du dosage de la prolactine en presence d'une galactorrhee.

The action of prolactin (PRL) in supra-physiological levels on the ovaries or on the hypothalamic-pituitary axis for the release of gonadotropins leads to a reversible inhibition of the cyclic functioning of the pituitary gland and of the ovaries. The consequences are either the production of immature follicles marked by anovulatory or dysovulatory cycles, or the absence of follicle production marked by amenorrhea. Thus, prolactin plays a major role in the productive system by its lactotropic and antigonadotropic effects. Through this study we intend to try to determine the diagnostic value of the association of the cyclic dysfunctions with galactorrhea by measuring the prolactin levels in 2236 patients complaining of galactorrhea. Measurements of FSH and LH levels were also performed in 236 women among those consulting for infertility associated with galactorrhea. The results obtained showed that galactorrhea was associated with prolactenemia in only 17% of cases and of the ovaries was proportional to the prolactin in blood.

La galactorrea como efecto secundario de la fluoxetina / Galactorrhea as side effect of fluoxetine

La fluoxetina es un antidepresivo utilizado ampliamente durante varios años. Los efectos secundarios relacionados con la prolactina han sido escasamente detectados. Se plantea un caso clínico de galactorrea inducida por fluoxetina y su evolución dosis-dependiente. (AU)

[Hyperprolactinemia in subclinical hypothyroidism]. / Hiperprolactinemia en el hipotiroidismo subclínico.

Most patients with subclinical hypothyroidism are asymptomatic; however, when this disorder is associated with alterations of the lactotroph, clinical and biochemical manifestations are evident, along with involvement of the gonadotrophic function. In this report, we selected 11 women with hypothyroidism, 5 of them in stage I and 6 in stage II. In all of them, the thyroid function was altered while the most affected was the gonadal axis. The available literature on this subject is scarce, so that we propose a systematic investigation in order to exclude other associated disorders.

Hiperprolactinemia em el hipotiroidismo subclínico / Hyperprolactinemia in subclinical hypothyroidism

En su gran mayoría los enfermos portadores de hipotiroidismo subclínico (HScl) son asintomáticos. Sin embargo, hemos tenido la oportunidad de entrevistar a enfermas con dicha patología, con manifestaciones clínicas y bioquímicas del sector lactotrófico adenohipofisario. Para explicar nuestros hallazgos seleccionamos a cinco mujeres con hipotiroidismo estadio I y seis en estadio II, comprobando que a medida que se profundiza la enfermedad, más se altera el eje gonadotrófico. Al resultar tan escasa la información bibliográfica diseñamos una sistemática de estudio de los diversos ejes neuroendocrinos en esta afección, con el fin de excluir otra noxa asociada.

Hiperprolactinemia em el hipotiroidismo subclínico / Hyperprolactinemia in subclinical hypothyroidism

En su gran mayoría los enfermos portadores de hipotiroidismo subclínico (HScl) son asintomáticos. Sin embargo, hemos tenido la oportunidad de entrevistar a enfermas con dicha patología, con manifestaciones clínicas y bioquímicas del sector lactotrófico adenohipofisario. Para explicar nuestros hallazgos seleccionamos a cinco mujeres con hipotiroidismo estadio I y seis en estadio II, comprobando que a medida que se profundiza la enfermedad, más se altera el eje gonadotrófico. Al resultar tan escasa la información bibliográfica diseñamos una sistemática de estudio de los diversos ejes neuroendocrinos en esta afección, con el fin de excluir otra noxa asociada. (Au)

[The basal concentration and characteristics of the diurnal secretory rate of prolactin in women with primary hypothyroidism]. / Bazal'na kontsentratsiia ta osoblyvosti dobovoho rytmu sekretsiï prolaktynu u zhinok, khvorykh na pervynnyi hipotyreoz.

Basal concentration was measured of prolactin (PRL) as were its diurnal fluctuations in blood depending on the clinical association of primary hypothyrosis (PH) with lactorrhea-amenorrhea, lactorrhea only or lactorrhea associated with disturbances in menstrual and reproductive functions that differ from those in amenorrhea, and without such disturbances. Patients with lactorrhea-amenorrhea syndrome present with continual hyperprolactinemia and no physiological diurnal rythm of PRL secretion. In patients presenting without amenorrhea, and basal hyperprolactinemia, lactorrhea and disordered menses result from transitory "night-time" hyperprolactinemia. PH patients who do not present with lactorrhea and disordered menstrual and reproductive function show physiological diurnal rythm of PRL secretion, with its parameters corresponding to those in healthy women. The development of hyperprolactinemia in PH is not age-related; neither is it associated with severity of hypothyrosis.

Primary low cerebrospinal fluid pressure syndrome with galactorrhea: findings at MR imaging.

A case of primary low cerebrospinal fluid (CSF) pressure syndrome with galactorrhea is reported. Magnetic resonance imaging demonstrated diffusely enhanced meninges, edematous brain, and enlarged pituitary gland. Coincidental enlargement of pituitary gland and edematous brain due to low CSF pressure compressed the pituitary portal system. The low-perfused anterior lobe of pituitary gland would be the mechanism of galactorrhea.