Endocrine Abstracts

Introduction: Finding the cause of gynecomastia and galactorrhea can be challenging, hence one of the most important cornerstones is detailed case history. Hereby we present gynecomastia and galactorrhea case, caused by drug abuse.

Case: A 24-year-old male, 3 years suffering from gynecomastia and galactorrhea, came for an endocrinologist consultation in 2020. As known from documentation laboratory blood results, lungs X-ray and abdominal ultrasound did not reveal any pathological changes. Chest ultrasound confirmed gynecomastia without any lymph nodes changes, although repeated prolactin concentration (165,26 mU/l) stayed in the normal range (89-365 mU/l). Unfortunately, due to the pandemic of Covid-19, further investigation stopped. The patient was referred for the consultation of an endocrinologist in 2021 summer since heavy galactorrhea and gynecomastia remained. The patient denied any diseases, medication use, allergies, family history of endocrine diseases. Objective examination showed normal body mass (BMI 24,9 kg/m²), heavy whitish secretion from both nipples, normal volume testes (20 ml). Laboratory blood tests were done in July 2021- moderate hyperprolactinemia was observed (419,44 mU/l). The patient was referred for the head MRI, no pathological findings were identified in the hypothalamus-pituitary region. The case was discussed in the multidisciplinary meeting and it was suggested to abstain from the medical treatment, to repeat testicular and abdominal ultrasound, lungs Xray for ruling out an active oncology process, to perform a cytological examination of secretion, to review the history of the case including possible drug abuse. While planning further investigations during the next consultation, the patient unwillingly confirmed regular cocaine abuse and discontinued further testing.

Conclusion: after taking cocaine, the levels of prolactin in the blood fall to baseline. However, hyperprolactinemia develops within 4 days of dosing (in the absence of repeated administration) [1]. These prolactin fluctuations, as well as unwillingness to reveal drug abuse, makes gynecomastia and galactorrhea causes identification challenging in drug users.

1. Walsh S.L., Stoops W.W. Et al. 2009. Repeated Dosing with Oral Cocaine in Humans: Assessment of Direct Effects, Withdrawal and Pharmacokinetics. Exp. Clin. Psychopharmacol.