Endocrine Abstracts

Introduction

It has been observed that in patients with depression and anxiety disorders dopamine secretion is suppressed, therefore prolactin secretion increases. Prolonged hypercortisolemia causes a variety of psycho-emotional changes that may affect dopamine secretion.

Case

A 36-year-old woman was admitted to the Hospital of Lithuanian University of Health Sciences Kauno Klinikos due to a 10-year-lasting galactorrhoea, sleep disorder, mood swings, anxiety attacks, menstrual cycle disorder, and a high blood pressure (BP). Gestational diabetes, preeclampsia, and eclampsia were confirmed in 2010, during the pregnancy. After the childbirth the state has gotten worse, the discharge from the nipples has not disappeared after stop of breastfeeding. Breast ultrasound and biopsy, head MRI were performed because of the galactorrhoea – no pathology were observed. Three groups of antihypertensive drugs were prescribed, but hypertension was still poorly controled. There was no history of other medication, head or chest trauma. No physiological or organic causes of hyperprolactinemia were found.

Physical examination

BMI – 29.76 kg/m², central distribution of adipose tissue. Facial hyperaemia. Pink stretch marks were observed: 1.5 cm wide on the arm, thigh, and abdomen area. Hirsutism based on the Ferryman-Gallwey score – 8. Milky white nipples discharge was observed. Thyroid I°- firm, uneven. BP 158/103 mmHg, HR 83 bpm. Other systems: no abnormalities detected.

Laboratory tests

Metanephrine, normetanephrine, aldosterone, renin, thyroid hormones - all in normal ranges. Prolactin 914 mu/I (n.r. 105–548), macroprolactin 78 proc. Head MRI - pituitary area without pathology. Overnight 1 mg Dexamethasone suppression test (DST) - pathological, cortisol after DST 382.9 nmol/l (n. < 50). Low-dose Dexamethasone suppression test (LDDST) - pathological, no cortisol suppression. ACTH 0.4 pmol/l (1.63–14.15). Abdominal CT scan: in the left adrenal gland an oval, well-defined 5.8 × 3.8 cm mass, heterogeneous with calcifications, very vascularized, accumulates contrast. Patient was diagnosed with ACTH-independent Cushing’s syndrome. A laparoscopic left adrenalectomy was performed. Histological results - adrenocortical adenoma. Post-operative treatment included Hydrocortisone 30 mg/p replacement therapy. Patient’s sleep quality and psycho-emotional state improved, galactorrhoea subsided completely within 1 week post-operation. Prolactin 352–294 mu/l.

Conclusion

Physiological and organic causes of hyperprolactinemia were not identified. Since the patient suffered from long-term psycho-emotional alterations dues to hypercortisolemia and cessation of galactorrhoea were observed after the surgical treatment of adrenal adenoma, galactorrhoea can be considered as Cushing’s syndrome complication. To our knowledge, a few similar clinical cases have been reported where galactorrhoea was attributed to psycho-emotional disorders in the context of the other diseases.