Endocrine Abstracts

Lactation is under the control of the anterior and posterior pituitary via prolactin and oxytocin release. A number of galactogogues, including dopamine antagonists, have been described and used with success in lactation induction. To date, there are no reports in the literature of their use in patients with panhypopituitarism. We present the case of a forty-year-old female known to endocrinology services with a background of anterior panhypopituitarism and AVP deficiency associated with a hypoplastic pituitary. At age forty, she underwent in-vitro fertilisation and delivered a pre-term baby boy at 30+1/40 gestation. The patient expressed wishes to breast-feed post-partum. Metoclopramide 10mg TDS was commenced which was continued during the breast-feeding period. This was well-tolerated with neither maternal side effects nor adverse neonatal outcomes. The patient expressed 40ml/three hours breastmilk on average with a maximum of one supplemental feed required per day. One week after breastfeeding was stopped, the patient suffered a seizure secondary to acute hyponatraemia, serum sodium 112mmol/l, urine sodium 84mmol/l, serum osmolality 239mmol/kg, urine osmolality 371mmol/kg, clinically euvolaemic. Oral fluid intake had been increased during the breastfeeding period and, after stopping breastfeeding one week prior to her seizure, she had not resumed pre-breastfeeding levels of fluid intake. This resulted in additional free fluid absorption while on regular Desmopressin and a positive fluid balance with subsequent hyponatraemia. She recovered well with no further seizure episodes. There are few randomised control trials with small sample sizes studying Domperidone and Metoclopramide in mothers of preterm babies with insufficient milk supply. Their use for lactation induction in this cohort remains ‘off-label’. However, there are no reports of adverse neonatal outcomes secondary to the use of pharmaceutical galactogogues. Further studies are required in women with panhypopituitarism to establish safety and efficacy.