Endocrine Abstracts

Introduction: Mammary duct ectasia (MDE) is an inflammatory breast disease characterised by dilation of major ducts and periductal inflammation. MDE occurs commonly in women undergoing menopause. The etiology has not been well defined but previous studies described an association between high prolactin and MDE.

Case Report: A 42-year-old female was admitted to our hospital with complaints of galactorrhea, amenorrhea, mammary gland tenderness and breast discomfort. Tests revealed serum prolactin level of 85 ng/ml and breast ultrasound showed dilated anechoic ducts and marked cystic ectasia. A 15×12 mm complex cystic lesion in right breast and several enlarged lymph nodes were found in right axillae. Mammography revealed thickened breast tissue with diffuse MDE without any calcification. Pituitary MRI showed 5.5×5.0×2.5 mm pituitary adenoma. Treatment with cabergoline 0.5 mg twice a week, warm compress and antibiotic started. Cabergolin dose is progressively increased to 2 mg per week. Prolactin level reached to 20 ng/ml and tumor size reduced to 3×3×1.5 mm in 6 months. Although treatment with cabergoline, resulted in improvement of breast symptoms and galactorrhea, diffuse MDE was reported in repeat ultrasound. Cabergoline dose is increased and the patient is still being followed up.

Discussion: In the present case, we hypothesize that there was an association between abnormal prolactin secretion and development of MDE. Shousha et al. discribed three cases with marked MDE and chromophobe adenomas. Peters et al. concluded that MDE is due in part to increased prolactin secretion. They also concluded that MDE may cause transient hyperprolactinemia. MDE induced by sulpiride-associated hyperprolactinemia was also discussed in literature. In our case; diffuse MDE may have been developed as a result of changes in prolactin levels. We conclude that increased prolactin secretion leading to chronic inflammation and fibrosis may cause to persistence of ductal dilatation.