Re: Amenorrhea
From: Zachariah Newton (zbnewton@bellsouth.net)
Thu Oct 6 20:47:20 2005
sAm:
I would add fractionated T3/T4, as T3 abnormality might not be reflected in
TSH.
Your post is thoughtful and studious. Lexapro or nipple stimulation could
well be related.
As you say, the secretions may not be true galactorrhea. The fat content is,
indeed, critical on a clinical basis.
And, then, there could be a prolactin elevation with a variant molecule not
detected by orthodox procedure. I wouldn't count on that.
Hey, mon, yuse is doing good.
zbn
--
I would add fractionated T3/T4, as T3 abnormality might not be reflected in
TSH.
>----- Original Message -----
From: "Atkinson, Samuel M" <ATKINSONS@mail.ecu.edu>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Thursday, October 06, 2005 2:58 PM
Subject: Re: Amenorrhea
> Your Question is interesting. How was galactorrhea confirmed by micro.
> True galactorrhea must have fat.. Thus did you have an oil red O stain
> for fat cells. True galactorrhea is almost always accompanied by an
> elevation of prolactin. Most causes listed in Speroff also elevate
> prolactin. As long as the prolactin is low, there is no medically
> dangerous condition. Common causes of true galactorrhea are high
> estrogen pills of decades ago, suckling, and all of the psychotropics.
> But all of these cause elevations of prolactin. So I suspect an
> intraductal lesion unless you have an oil red O positive slide for fat
> cells. I would not suggest lowering the dose of Lexapro just to get rid
> of galactorrhea. Tell her to quit checking the nipples, just as we do to
> postpartum pts who haven't yet dried up.Treat her psychi appropriately.
> I would also consider the amenorrhea to be due to the MIRENA. I would
> not remove it just so she could have a mense. True, amenorrhea and
> galactorrhea combined hint at pit tumor but you have ruled that out with
> a normal prolactin. If she really wants to bleed, cycle her with
> Premarin and Provera.
> sAm Atkinson
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
> E. Siegel, M.D.
> Sent: Wednesday, October 05, 2005 6:20 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Gyn: Amenorrhea
>
> 38 YO P2002 with a Mirena IUD since 12/02; she's been amenorrheic since
> placement.
>
> She complains of expressable galacotorrhea (proven by micro) for a
> month, emotional changes, moody, hot, etc. She is seeing a psychiatrist
> and is Lexapro 30 mg/day, and before he adjusts her meds, the question
> "are my hormones normal" has come up.
>
> FSH 6.9, TSH 4.3 (normal), and AM non-fasting prolactin before breast
> exam is 2.5, which is a bit low (normal 2.9 to 30).
>
> Any thoughts?
>
> Garry
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
