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Breast disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
May arise from a single or multiple ducts and can be categorised by aetiology: Physiological: intermittent, spontaneous yellow/brown/green/white discharge. Common in multiparous females. Treat conservatively.Duct ectasia (see below).Periductal mastitis: affects younger women and is associated with smoking. Can be unilateral or bilateral with symptoms similar to duct ectasia, however, the nipple discharge is typically offensive. Staph. aureus, Enterococci, anaerobic Streptococci and Bacteroides are most commonly implicated. Treat with appropriate antibiotics and advise smoking cessation.Intraductal papilloma – see below.Galactorrhoea: bilateral discharge of milk not associated with breast-feeding. Causes are those that lead to hyperprolactinaemia, e.g. dopamine antagonists, pituitary adenoma, Cushing’s disease and hypothyroidism. Management involves treatment of the underlying cause +/- dopamine receptor agonist, e.g. bromocriptine.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Flutamide has a fairly short duration of action and, as a result, must be taken three times daily. One of the most serious and potentially fatal side effects of flutamide is hepatotoxicity which can give rise to problems such as transaminase abnormalities, hepatic encephalopathy, and necrosis. Cholestatic jaundice with occasional resulting deaths have also been reported. Therefore, periodic liver function tests are important when the first indications of liver symptoms appear, or for those patients on long-term therapy. These are often carried out monthly for the first four months followed by periodic tests at the first symptom of liver disorder (e.g., influenza-like symptoms, dark urine, pruritus, persistent anorexia, jaundice, abdominal pain). Other side effects include GI disturbances (e.g., nausea, vomiting, diarrhea, abnormal appetite), galactorrhea, asthenia, insomnia, fatigue, and drowsiness. Another common side effect is breast abnormality (e.g., gynecomastia), which affects approximately 60% of patients, 10% of whom suffer severely. For this reason, other NSAAs are now more widely prescribed as they produce fewer of these side effects.
Familial Isolated Pituitary Adenoma
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Patients with increased GH and/or IGF-1 secretion often have acromegaly and high risk for cardiovascular, cerebrovascular, rheumatologic/orthopedic, and metabolic complications. Patients with prolactinoma show increased plasma prolactin levels, which may induce amenorrhea/oligomenorrhea, galactorrhea, infertility, impotence, headaches, and visual disturbance [2,3,13].
Non-typhoidal Salmonella soft-tissue infection after gender affirming subcutaneous mastectomy case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Branden T. Barger, Mikhail Pakvasa, Melinda Lem, Aishu Ramamurthi, Shadi Lalezari, Cathy Tang
Last, an infrequent, though well-documented complication following breast surgery is galactorrhea and galactocele formation [33,34]. Galactorrhea after breast surgery is thought to be due to increased levels of prolactin from stress as well as from inadvertent stimulation of nerves in the chest wall and breast tissue during surgery [35]. Galactorrhea can also be the result of an undiagnosed pituitary tumor, or a side effect of antipsychotic medications such as risperidone. In the case of antipsychotics, the D2-dopamine receptor blocking action of these medications turns off the dopamine-prolactin negative feedback loop leading to hyperprolactinemia [36]. To our knowledge, this phenomena has not yet been described among patients undergoing chest masculinization. The patient had recently transitioned to risperidone, which has the highest reported rates of hyperprolactinemia in the literature [37]. Confirmation of fluid as breast milk is not usually done by laboratory testing, and was not performed in our patient as it was not available at our institution. However, the copious white fluid diffusely present in our patient’s surgical plane along with his elevated prolactin levels raised suspicion for galactorrhea. After discussion with both endocrinology and psychiatry services, risperidone was discontinued and his prolactin levels down trended. It remains unclear, whether our patient’s high prolactin levels contributed to his complicated recovery.
Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population
Published in International Journal of Psychiatry in Clinical Practice, 2022
D. A. Coronel, F. R. De la Peña, L. Palacios-Cruz, D. Cuevas, S. Duran
The clinical inclusion criteria were weight, body mass index (kg/m2), serum glucose (mg/dL); hyperglycaemia was defined with higher levels than 100 mg/dL and the serum creatinine was defined as abnormal with higher levels than 0.9 mg/dL (Oh & Briefel, 2011). The medical diagnoses included were hypothyroidism, hypertension, hypercholesterolaemia and hypertriglyceridaemia, as well as finding pituitary adenoma in those patients with a cranial magnetic resonance report. Clinical data as galactorrhoea, decline in sexual function, fatigue, headache, myalgia, weight gain, infertility, amenorrhoea and erectile dysfunction, which were recorded in the patients’ clinical records or follow-up monitoring. HyperPRL was defined as serum PRL greater than 25 ng/mL among women and greater than 20 ng/mL among men (Chahal & Schlechte, 2008).
The prevalence of hyperprolactinaemia in subfertile ovulatory women and its impact on fertility treatment outcome
Published in Journal of Obstetrics and Gynaecology, 2022
Maria Wojcik, Saad Amer, Kanna Jayaprakasan
National fertility guidelines dissuade health professionals from prolactin testing in eumenorrheic subfertile women. The National Institute for Health and Care Excellence (NICE) recommends prolactin testing only if subfertile women have signs of an ovulatory disorder, galactorrhoea or a pituitary tumour (National Institute for Health and Care Excellence 2017). Similarly, the American Society for Reproductive Medicine (ASRM) recommends against prolactin testing as part of routine infertility investigations, unless a woman presents with irregular menses (American Society for Reproductive Medicine 2015). Although most fertility specialists in the UK follow these recommendations; prolactin is still measured routinely by general practitioners who usually initiate investigations for all subfertility women. Finding of subtle hyperprolactinaemia in these women is not uncommon and may pose a clinical dilemma as to whether to act upon or ignore it. Such finding may also create an unnecessary anxiety among women and may necessitate further evaluation to rule out any prolactin producing tumour in the pituitary (prolactinoma). Another area of concern is whether it has any impact on the outcome of fertility treatment and the chances of pregnancy.