Endocrine Abstracts

Introduction: Galactorrhea is a common symptom of raised prolactin irrespective of cause of hyperprolactinemia. Whereas pituitary prolactinoma is the commonest cause, there are many other causes of increased prolactin including chest wall injuries or chest surgery. Galactorrhea without prolactin increase has been reported as well. We describe a case of galactorrhea following thoracoscopic resection of schwannoma from apex of left hemithorax.

Clinical Case: A thirty four years old patient presented with symptoms of chest infection. X ray chest showed left basal consolidation and a small well circumscribed incidental shadow was noted on left apex, she had no symptoms relating to the apical shadow. She was treated for community acquired pneumonia. On discharge an outpatient CT scan of neck and chest was arranged. CT described a well circumscribed 2.4 cm apical mass suggesting either a vascular lesion or a neurofibroma. Subsequent MRI suggested high suspicion of a schwannoma. Three months post MRI she had a successful left thoracoscopic dissection for removal of schwannoma, histology report was in keeping with Schwannoma. Ten days following surgery she noted engorgement of left breast which was followed by bilateral galactorrhea. She had no headache or visual symptoms to suggest any pituitary lesion. She had normal mensuration following recent stoppage of oral contraceptive pill. Reproductive hormonal profile showed raised prolactin of 2090 mU/L (normal value 102–496 mU/L) and normal LH, FSH & estradiol. TFT, LFT and renal functions were normal as well. Galactorrhea and Prolactin improved gradually. Prolactin became normal after 7 weeks; mild expressive galactorrhea persisted for further few weeks.

Conclusion: This case shows galactorrhea in this patient was secondary to prolactin secretion in response to surgical stress to chest wall. The mechanism behind is neurogenic reflex which stimulates prolactin via suppression of dopamine.