Endocrine Abstracts

Treatment of patients with a microprolactinoma is considered when hypogonadism is present in the form of menstrual cycle dysfunction or infertility. The presence of galactorrhea alone does not require treatment unless it is bothersome to the patient. The exact etiology of granulomatous mastitis is still unclear. Hyperprolactinemia has been identified as a possible factor in the occurrence and development of granulomatous mastitis. A 42-year-old female patient was referred to our clinic because of persistent hyperprolactinemia (3-4 times the upper limit) and MRI finding of a 5 mm microadenoma. This workup had been performed by her gynecologist because of menorrhagia and slightly irregular menstrual cycles. Her gynecological condition was to be treated with a levonorgestrel-releasing intrauterine system. She was not taking any medication. Her medical history was unremarkable, with the exception of a breast abscess that required surgical intervention twice in the last two years. Both times a biopsy of the lesion was performed, which revealed lobulocentric granulomatous inflammation, while the microbiologic analysis was sterile. Autoimmune disorders were excluded. No previous or current galactorrhea was detected. Laboratory tests revealed no other pituitary dysfunction. Only follow-up was recommended. Transient hyperprolactinemia due to recent breast manipulation was considered, but prolactin levels remained consistently elevated. The size of the microadenoma also remained stable. At the age of 44, she developed oligomenorrhea and occasional nipple discharge, that did not correspond to typical galactorrhea. Ultrasonography revealed duct ectasia and an inhomogeneous, hypoechoic, oval lesion in the upper left quadrant of the left breast that probably corresponded to a chronic abscess. FNA of the lesion confirmed persistent inflammation. At this point, we decided to change the approach and introduced a dopamine agonist. This was followed by prolactin level decrease, microadenoma shrinkage, and repeated ultrasound examination confirmed the regression of the long-standing inflammatory breast process. Hyperprolactinemia as a possible etiologic and predisposing factor for the occurrence and development of granulomatous mastitis should not be neglected. It seems that the presence of granulomatous mastitis should be taken into account when deciding on the introduction of a dopamine agonist in a patient with microprolactinoma and no other indication for drug therapy. Further clinical studies are needed to clarify the role of dopamine agonist use in patients with granulomatous mastitis and microprolactinoma.