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  • Title: The significance of galactorrhea in patients with normal menses, oligomenorrhea, and secondary amenorrhea.
    Author: Davajan V, Kletzky O, March CM, Roy S, Mishell DR.
    Journal: Am J Obstet Gynecol; 1978 Apr 15; 130(8):894-904. PubMed ID: 565142.
    Abstract:
    Thyroid-stimulating hormone and prolactin (PRL) were measured in a group of 149 women with galactorrhea. Three of these patients were found to have primary hypothyroidism. In the remaining 146 patients, the PRL assay was correlated with the menstrual history and the results of hypocycloidal polytomography. Sixty-two per cent of these patients had hyperprolactinemia and 35 per cent had abnormal tomograms. Nine patients with abnormal x-rays had normal prolactin levels. None of the patients with normal menses and normal PRL was found to have an abnormal x-ray. Fourteen of the 15 patients with PRL levels greater than 200 ng. per milliliter had abnormal tomograms. Almost 70 per cent of patients with secondary amenorrhea and low estrogen status had abnormal x-rays. In patients with oligomenorrhea and secondary amenorrhea with normal estrogen status, it was not possible to differentiate between patients with normal or abnormal tomograms based on the level of serum PRL. Polytomography remains the single most important diagnostic test in establishing the presence of a pituitary tumor. Thyroid-stimulating hormone and prolactin (PRL) were measured in 149 women with galactorrhea; 3 were found to have primary hypothyroidism. In the remaining 146, the PRL assay was correlated with menstrual history and results of hypocycloidal polytomography. 14 of 15 patients with PRL levels greater than 200ng/ml had abnormal tomograms. Almost 70% of patients with secondary amenorrhea and low estrogen status had abnormal X-rays. Differentiation among patients with normal or abnormal tomograms based on serum PRL level in patients with oligomenorrhea and secondary amenorrhea with normal estrogen status was not possible. A medical panel discussion of the study's design and results focuses on high level radiation exposure during diagnosis and the relationship of oral contraceptive (OC) use to galactorrhea, including temporal correlation between time of ingestion and onset of symptoms. Galactorrhea has been associated with prior use of OCs, but this study gives no data due to the lack of reliable OC-use history by many of the patients. Thyroid surgery is recommended for women wishing fertility because pregnancy could stimulate tumor growth and cause sudden blindness.
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