Endocrine Abstracts

Case 1: 38 year old was referred for sub-fertility. She had one normal childbirth 5 years ago. There was failure to lactate following the childbirth. There was some puerperal blood loss, but she resumed normal menstrual periods and had no other manifestations of hypopituitarism. Pituitary profile showed normal results FSH 2.7 IU/l; LH 1.5 IU/l; 0900 h cortisol 305 nmol/l/l/ TSH 2.85 μ/l. Prolactin was 85 μ/l. IGF1 18.6 nmol/l. Short synacthen was normal. Previous MRI showed normal pituitary. She had difficulty conceiving second child. Day 21 progesterone was >30 suggesting ovulation. Few months after being seen in clinic she conceived naturally and is currently expecting her second child. There was no history of recurrent infections.

Case 2: 25 year old was referred for labile mood and irregular periods. Investigations by her general practitioner had shown low prolactin level on two occasions. She has two children and had failure of lactation following childbirth. Her main symptoms were consistent with mild depression. Her periods were mildly irregular but she had conceived twice naturally. 0900 h pituitary profile was normal with 0900 h cortisol of 550 nmol/l. Prior to being seen in clinic she had an MRI of pituitary, requested by her GP, which showed no abnormalities. There was no history of recurrent infections.

Discussion: We present two cases of isolated hypoprolactinaemia with failure of lactation following childbirth. Both detected incidentally and referred to endocrinology for evaluation. Most cases of hypoprolactinaemia are secondary to pituitary tumours/surgery or other pituitary disorders. There are only occasional case reports of isolated hypoprolactinaemia.