Takenori Shioji

Primary hypothyroidism and galactorrhea

Ten of 16 women with primary hypothyroidism and high thyrotropin (TSH) concentrations had high serum prolactin (PRL) concentrations. A positive correlation was observed between the basal TSH and PRL levels in the hypothyroid patients. Five of these patients complained of persistent galactorrhea after delivery. After treatment with triiodothyronine (T3), the elevated TSH and PRL levels fell to within normal ranges, and the galactorrhea disappeared. It is suggested that the elevated serum PRL levels of patients with primary hypothyroidism are mediated by feedback-induced thyrotropin-releasing hormone (TRH) secretion or an enhanced response to endogenous TRH, and that the combination of delivery and the PRL excess may induce persistent galactorrhea in patients with primary hypothyroidism.

Pregnancy Following 2-Bromo-α-Ergocryptine (CB-154)-Induced Ovulation in an Acromegalic Patient With Galactorrhea and Amenorrhea

An acromegalic patient with galactorrhea-amenorrhea who conceived following long-term 2-bromo-alpha-ergocryptine (CB-154) therapy is described. During CB-154 therapy, determinations of serum prolactin (PRL), luteinizing hormone (LH)-human chorionic gonadotropin, follicle-stimulating hormone a reduction in PRL level followed by an LH peak, a rise in basal body temperature and menstruation. The patient became pregnant during the next cycle, but therapeutic abortion was performed because of the active acromegaly. These results demonstrate that CB-154 can restore ovulatory function not only to the patient with a hypothalamic disorder but also to the acromegalic patient with an enlarged sella turcica.

Pregnancy following thyroid hormone treatment in a patient with amenorrhea-galactorrhea due to primary hypothyroidism.

A 32-year-old female with amenorrhea-galactorrhea due to primary hypothyroidism was treated with thyroid hormones, and serum levels of thyrotropin (TSH), prolactin (PRL), triiodothyronine (T3), thyroxin (T4), and T3 resin sponge uptake (RT3U) were measured throughout the course of treatment. The elevated serum levels of TSH and PRL fell into the normal range following T3 treatment. Subsequently, the menstrual cycle was restored within 1 month, and galactorrhea completely ceased and conception was achieved within 3 months. Desiccated thyroid was administered during pregnancy, and the patient gave birth to a female infant. Impaired secretion of PRL during pregnancy and poor milk secretion with blunted response of PRL to the suckling stimulus during the puerperium were noted.

Augmentation of Puerperal Lactation by Oral Administration of Sulpiride

The effect of oral administration of sulpiride on PRL secretion and initiation of puerperal lactation was studied in 130 randomly selected primiparous nursing mothers. Sixty-six women were given 50 mg sulpiride orally twice a day during the first 7 days of the puerperium (sulpiride group). Sixty-four women were given a placebo in the same way (control group). The mean (+/-SE) total milk yield during the first 5 postpartum days in the sulpiride group (1211.7 +/- 65.0 ml) was significantly greater than that in the control group (916.0 +/- 66.0 ml). Every other day determinations of serum PRL levels revealed significantly higher concentrations in the sulpiride group than in the control group. A single oral dose of 50 mg sulpiride raised serum PRL levels for 12 h, with a peak level at 2 h after dosing in 7 women on the second postpartum day. These data suggest that sulpiride given orally promotes the initiation of lactation in puerperal women by stimulating PRL secretion.