Endocrine Abstracts

Introduction: Epilepsy and anti-epileptic medications can be associated with various endocrine disorders namely, polycystic ovary syndrome, premature ovarian failure, hypothalamic amenorrhoea, functional hyperprolactinaemia and rarely galactorrhoea. Here, we present a lady who developed intermittent episodes of galactorrhoea suspected to be due to primary generalized seizures.

Case report: A 50-year-old lady was referred for investigation of elevated prolactin and galactorrhoea for two years. Detailed evaluation of medical history revealed history of epilepsy, but was not on anti epileptics as she was seizure free. She continued to be seizure free but had intermittent vacant episodes lasting for a few seconds. She was not on any medication except mirena coil.

General examination was unremarkable and visual field was normal. Initial serum prolactin was 1027 IU/l. Repeat blood test showed a serum prolactin of 884 IU/l, TFT normal, FSH 14.4 IU/l and LH 3.8 IU/l. Magnetic resonance imaging did not reveal any pituitary lesion.

In view of the suspicion of galactorrhoea secondary to seizure activity associated with vacant episodes, an EEG (Electroencephalogram) was requested. EEG revealed continues generalized seizure activity suggesting a diagnosis of primary generalized epilepsy. She was referred to the neurologist for the primary treatment of epilepsy. The plan is to start her on cabergoline if galactorrhoea does not resolve with anti epileptics.

Discussion: Elevation of serum prolactin level is seen following generalized tonic-clonic, complex partial, some times in simple partial seizures and moderately high serum prolactin levels seen in interictal epileptiform discharges. We suspect our patient has been having interictal epileptiform discharges and probably generalised seizures activity intermittently during the vacant episodes. This would explain moderately high serum prolactin levels causing intermittent galactorrhoea. Endocrine dysfunction has a complex mechanism in people with epilepsy and needs judicious investigation before any therapeutic intervention.