NONPUERPERAL LACTATION: A Review with Case Reports

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Abstract
Lactation occurring in nonpuerperal women may reflect serious underlying disease. It has been reported in patients with chromophobe (Forbes-Albright syndrome), eosinophilic, and basophilic pituitary adenomata. Pituitary dysfunction (dyspituitarism) is implicated in patients with prolonged lactation following childbirth with amenorrhea and utero-ovarian atrophy (Chiari-Frommel syndrome) and in lactating women with no antecedent pregancy but with uterine atrophy and hypoestrinism (Ahumada syndrome). A further instance of dyspituitarism is seen in patients who lactate following oophorectomy or in early menopause. In addition to increased prolactin-like effect, increased pituitary gonadotropins are found in contrast to the Chiari-Frommel and Ahumada syndromes where the gonadotropins are low or absent. Lactation is occasionally seen as a result of persistent stimulation of afferent neural arc from the breast in nonpuerperal women following thoracoplasty, herpes zoster, chronic abscess formation, or secondary to persistent digital or oral manipulation. Finally cyclic lactation (menstrual galactorrhea) may be seen in normal women coincident with the onset of menstrual bleeding and may continue regularly for years. In these women cyclic breast changes occur with proliferation and increased secretory activity beginning at the time of ovulation with involution occurring at the onset of menstruation.
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