異常乳汁分泌を呈した男性慢性腎不全患者の一例

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タイトル別名
  • A Case of Male remit Patient with Galactorrhea
  • イジョウ ニュウジュウ ブンピ オ テイシタ ダンセイ マンセイ ジンフゼン

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Abnormal lactation (galactorrhea) was observed in an uremic male patient aged 31, maintained on regular dialysis treatment (RDT). Proteinuria was firstly pointed in 1971, and he was diagnosed as chronic glomerulonephritis by renal biopsy. RDT was started in January 1977. Patient noticed abnormal lactation in January of 1978 by himself. At this time, he had been given hydroxy-alumi-nium gel, mufti-vitamin powder, a-methyldopa, chlorpheniramin maleate and methochlopramide. Simple and computed axial tomography revealed no abnormality in sella turcica. Basal prolactin levels in the blood showed very high value; 839-1373 ng/ml (normal ranger 2.0-20.0 ng/ml). Prolactin response to TRH infusion (500, ug) was negative. The response of FSH and LH to LH-RH infusion (100 fig) was also negative. These results suggest hypothalamo-pituitary dysfunction in this case. Basal LH level (99.9 mIU/ml) was high and testosterone was low (410 ng/100 ml) in normal range (300-850 ng/100 ml). These facts suggest that he had been in a state of hypogonadism. Four weeks after the cessation of drugs, we could not observe any change in lactation degree. In an attempt to diminish lactation, L-dopa was administered, but in vain. Then, CB 454 was administered (5 mg/day×45 days), and gradual decrease of lactation was observed, and prolactin was recovered to subnormal level. With cessation of CB-154, prolactin elevated to 78-234 ng/ml and the lactation reincreased apparently. The composition of his secreted milk was abundant in sodium, potassium and C8_14 saturated fatty acids compared to normal milk. It is concluded that the lacta-tion of this patient is induced by the long-term administration of a-methyldopa. Hypothalamo-pitui-tary dysfunction and hypoganadism are also contributing factors for lactation in this case, as ob-served in female cases with abnormal lactation.

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