Clinical Analysis And Relevant Investigations On The 50 Cases With Galactorrhea Symptoms

Objective:The hyperprolactinemia is one kind of the common endocrine dyscrasias, which usually occurs at the hypothalamic-pituitary axis and whose clinical manifestations are varied. Recently, the galactorrhea, as one of the clinical manifestations of the hyperprolactinemia, has attracted people's enormous attentions, since the hyperprolactinemia has been studied extensively. In additional, the galactorrhea is also one of the common clinical manifestations of the mammary diseases, which should be paid more attentions by doctors who major in breast diseases. Through the studies and analyses on the galactorrhea in the present paper, we hope to make people understand some diseases which are related to the galactorrhea symptom, pay more attentions to this clinical manifestations, find and treat some relevant diseases early. Methods:The 50 medical cases with the galactorrhea symptoms, which were treated at the Surgical Department of Breast and Thyroid in the China-Japan Union Hospital of Jilin University from July 2007 to March 2009, were selected and analyzed. The ages of cases range from 21 to 54, the average age being 36.2, and all the cases are female. The detected values of prolactin(PRL) range from 5.5ug/L– 266.8ug/L. All the patients were treated by physical examinations(For all the patients,there exist no space occupying lesions in their two-sided breasts upon palpations, and there are white,milky or jasmine discharge from single pole or multi poles by extruding their two-sided nipples), the prolactin diagnoses (the kits are provided by Tianjin Xie-He Medicine Company, and the radioimmunoassay was used, the used GC-2016 Gamma radioimmunoassay counter provided by Science and Technology Institute of China innovation Limited liability company), the B-type ultrasonic diagnosis (DP-8800 digital ultrasonic diagnosis system provided by Shenzhen Mindray Medical International Limited company, frequency: 10MHz liner prober), MRI diagnosis(U. S. A. GE Singal 1.5 superconductive MR machine), and the endoscopy diagnoses in mammary ducts(Beijing Bolaide FVY-980 hard tube endoscope system)In this study, the 3 variables were matched and analyzed: (1)different periods in menstrual cycle: 3, 12, 20 days after the menstruation is finished, the matched results among groups;(2)different age groups: 20～31,32～43,44～55; (3)PRL values: the regular value range in this study is 4-21ug/L, and the value of 21 ug/L is used to differentiate the heightened group and the normal group. With emphasis on the common causes of galactorrhea and the frequent diseases at the surgical department of galactophore and thyroid, the galactorrhea cases in this study were divided into five groups, 10 cases in each group: the hypophysoma, the thyroid disorders(including the primary auto immune hypothyroidism, the thyroiditis, the hypothyroidism co-existed with thyroiditis, the space occupying diseases in the mammary ducts(the papilloma in the mammary duct, the papillary carcinoma in the mammary duct), dilation of duct of breast, the control group with ten cases(the diseases of galactophore and thyroid as well as the hypophysoma are ruled out in these ten cases). The results have been analyzed in details. The values are subject to those which are detected 3 days after the menstruations are finished.Results:The physical examinations and the fiberoptic ductoscopy inspections have been carried out for all the patients to determine the lacto-deposit extents of the galactorrhea patients and make sure whether there are the space occupying diseases in the mammary ducts. All the selected cases have been inspected to measure the prolactin values, 22 cases in the regular range (44%) and 28 cases higher than the normal range (56%). There are 14 patients who found the galactorrhea symptoms by themselves and 36 patients whose symptoms were discovered by doctors. For all the 50 cases, by extruding their two-sided nipples, there are discharges from single pole or multi poles, the colors of which are milky or jasmine, and for one case, cheese-like substance discharges when the nipples is pressed. All the 50 cases are inspected to display the middle or severe lacto-deposit manifestations upon the fiberoptic ductoscopy inspections.In the 50 cases, breast feedings were presented in 41 cases, latexes adequate when breast-feedings for 28 cases according to their own words and latexes not adequate when breast-feedings for 13 cases according to their own words. Most of patients(32 cases) said their Menstruations are irregular, and 27 cases have miscarriage medical histories. In the 50 cases, 21 cases accompany with the breast indisposed symptoms, and 8 patients are in the group of breast duct dilation. The young children have the habits of touching the breasts for 2 cases accounted in their own words, and the young child has the habit of sucking nipple to sleep for 1 case according to her own words. Interruptions of pregnancies in recent half - one year were presented in 3 cases.The comparative result that concerns the prolactin values in the different periods in the menstrual cycle shows that: the PRL levels are the highest 12 days after the menstruations are finished(corresponding to the phase before the ovulation), the PRL values detected 20 days after the menstruations are finished (corresponding to the luteal phase) are lower, and the PRL levels are the lowest 3 days after the menstruations(corresponding to the follicle-growing period), which is in accordance with the theoretical result. However, the PRL values detected 3 days after menstruations is 2/3 of that detected 12 days after, which is not in agreement with the theoretical result. This can be seen as a result of that each patient has the respective and perhaps different menstrual cycle, and the patients with the menstrual irregularities have a high proportion (32 cases) in our study. The comparative result concerning the different age groups in female maturities shows that: the statistical results shows that P>0.05, which indicates the female PRL levels are not different in the different phases of maturity.The comparative result concerning the groups of different diseases shows that: in the cases with high prolactin values(>100ug/L), the hypophysoma patients have a high proportion, while the increased extents of the prolactin values that are induced by the mammary gland and the thyroid gland diseases is not great. Analyzed from the colors of the galactorrhea, a majority of the patients'discharge presents milky color, and the patients with mammary duct dilations spill over relatively dilute discharge. There are a small quantity of patients with jasmine discharge, which is considered to be caused by the incorrect methods when ending lactation or the blockade of the mammary ducts. In addition to investigating the clinical significance of high prolactin level, it is also necessary to pay attention to the fact that the prolactin value has the character of stress response, such as the strenuous exercise, the psychic trauma, the provocation, the physiologically and mentally tense states, the anesthesia and operation, and the diet, which may all make the patient's prolactin value increase transiently. Furthermore, prolactin metabolizes mainly through the kidney and partly through the liver, accordingly, the damages to the functions of the kidney and the liver, especially the renal failure, may result in high prolactin level in blood.Conclusion:1. The PRL value is different in the different phases in the mammary cycle, the highest before the ovulation, lower in the luteal phase, and the lowest in the follicle-growing period.2. The PRL value varies in time range from the puberty to menostasia, that is, the female PRL levels are not different in different phases of maturity.3. A lot of galactophore gland and thyroid gland diseases have the galactorrhea symptoms, and the fiberoptic ductoscopy inspection plays an important role in determining the causes of galactorrhea, accordingly, the clinical cases with galactorrhea symptoms should be inspected by means of the fiberoptic ductoscopy and the hormone detection.4. The galactorrhea can be seen as the clinical manifestation to diseases of many organs and systems, thus, we should pay attention to the galactorrhea symptom. Through the galactorrhea symptom, we may found some diseases related to the galactorrhea. Therefore,the attention to galactorrhea may be helpful to the early detections and timely treatments to the related diseases.