- Email: [email protected]
Galactorrhea and amenorrhea in burn patients
burns 34 (2008) 825–828
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Galactorrhea and amenorrhea in burn patients Navin Goyal *, Madhuri A. Gore, Ravi Shankar Department of General Surgery, L.T.M. Medical College, Sion, Mumbai 400022, India
article info
abstract
Article history:
Introduction: Galactorrhea and/or amenorrhea, although uncommonly reported in post-
Accepted 4 December 2007
burn patients, is a complex problem to treat. Patient is reluctant to volunteer history of these symptoms, unless asked specifically.
Keywords:
Aim: To study profile of adult female patients with galactorrhea and/or amenorrhea in post
Burns
burn period.
Galactorrhea
Materials and Method: A prospective study of all adult female patients presenting with or
Amenorrhea
detected to have galactorrhea and/or amenorrhea in post burn period was conducted over 6
Prolactin
month’s period. Detailed clinical examination, estimation of LH, FSH, Prolactin levels and Xray of skull was done in all patients. The data collected was analyzed. Patients with hyperprolactinemia and galactorrhea were treated with Bromocriptine for 3 weeks to 3 months. In all patients with amenorrhea, pregnancy was ruled out by gynecological examination and urine pregnancy test. Results: During this period, 30 patients (15.15%) were detected to have galactorrhea and/or amenorrhoea. The extent of burn in these patients was 20–65%of body surface area. Out of 30 patients, 5 had galactorrhea and amenorrhea, 1 galactorrhea alone and 24 had amenorrhea alone. Analysis of voluntary disclosures and detection on interrogation was done. Till the end of study, 4 patients with galactorrhea had complete relief, 2 patients reported reduction in discharge. Discussion: Galactorrhea was distressing for all and was always associated with high prolactine levels .The reverse was not true. All the patients had chest burns besides other body areas. Association was noted between menstrual aberration and ovulatory phase at the time of burn. Conclusion: Galactorrhea and menstrual disturbances do exist in female patients in reproductive age group in post burn period and patients should be especially interrogated for these symptoms by the burn care providers. # 2007 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Galactorrhea is defined as discharge of milk or milk-like secretion from the breast in the absence of parturition or beyond 6 months post-partum in non-breast feeding woman [1]. Post-burn galactorrhea, although relatively uncommon, is a complex problem to treat. Although the problem is itself very disabling and distressing for the patient, generally the patient is reluctant to divulge it to the treating physician either due to
inhibitions or because they do not link this problem to the burn injury.
2.
Materials and methods
It was a prospective study of all adult female patients with burn injury presenting with or detected to have galactorrhea or amenorrhea during 6-month period from February 2006 to
* Corresponding author. Tel.: +91 9999005756. E-mail addresses: [email protected] (N. Goyal), [email protected] (M.A. Gore), [email protected] (R. Shankar). 0305-4179/$34.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.12.001
826
burns 34 (2008) 825–828
Fig. 1 – Lay-out of patients.
July 2006. All patients were clinically examined and pregnancy was ruled out by gynecological examination and urine pregnancy test. Estimation of leutinising hormone (LH), follicle stimulating hormone (FSH) and prolactin levels was done at nuclear medicine department. X-ray of skull was taken in all patients. We did not examine thyroid hormone levels. All the galactorrhic patients with high levels of prolactin were treated with bromocriptine starting with 2.5 mg twice daily dose, which was increased upto 2.5–5 mg TDS till the symptoms were relieved. It was then continued in dosage of 2.5 mg thrice daily for 3 weeks and stopped.
3.
Results
In total 283 patients (198 women, 40 men and 45 children) visited to burns unit during study period. Out of 198 adult female patients, total 30 patients (15.15%) were found to have galactorrhea and/or amenorrhea (Fig. 1). The incidence of amenorrhea and/or galactorrhea was 15.15% in adult females while incidence of galactorrhea was 3.03%. Out of 30 women studied, only one patient volunteered her complaint to the clinician. In remaining 29 patients, the
condition was revealed by the patient on direct questioning and presence of galactorrhea was confirmed on clinical examination. Six patients had galactorrhea and 29 had amenorrhea (five had both amenorrhea and galactorrhea). Most of the women (93.33%) were in the fertile age group (16–45) with the median age of 28 years. Extent of burn ranged from 20% to 65% of body surface area with the majority having burn extent between 40% and 60%. All the patients had sustained chest wall burns (Table 1). Skull X-ray was normal in all patients. All patients in preovulation phase (18) at the time of injury continued to have amenorrhea after the injury but all in the post-ovulation phase (11) had one episode of menstrual flow after the burn injury and then had amenorrhea. In patients with galactorrhea, the symptom appeared between 2 and 5 months after-burns, with median period of 93 days. Out of 29 amenorrhic patient 5 were nulliparous, 2 primiparous and 22 multiparous. However out of 6 galactorrhic patients 5 were multiparous and 1 was primiparous (Table 2). None of the patients with amenorrhea was found to be pregnant on evaluation by the gynaecologist/obstetrician. As shown in Tables 3 and 4, no specific alteration of hormonal levels was detected in amenorrhic patients. But
Table 1 – Demographics of adult female patients with and without amenorrhea and/or galactorrhea
Age Fertile age group TBSA%c LOSd
With amenorrhea and/or galactorrhea
Without amenorrhea and/or galactorrhea
29.06 10.075a 28 (93.33%)b 43.16 8.757 33.86 11.509
28.28 12.069 144 (85.71%) 41.85 15.39 23.33 15.343
0.7371 0.2551 0.6515 0.0004
Not significant Not significant Not significant Significant
87 120 141 153 84 111
0.243 0.1067
Not significant Not significant
0.0207 0.3127 0.0424
Significant Not significant Significant
Body area having burn (no. of patients) Head 17 (56.67%) Neck 17 (56.67%) Chest 30 (15.15%) Upper limbs 23 (76.67%) Lower limbs 12 (40%) Abdomen 14 (46.67%) Chest burn representing % TBSA a b c d
13.73 0.868
Mean value standard deviation (S.D.). Number of patients (% of patients). Total body surface area %. Hospital length of stay.
(51.78%) (71.42%) (83.92%) (91.07%) (50%) (66.07%)
9.72 5.044
P-Value
<0.0001
Statistical significance
Significant
827
burns 34 (2008) 825–828
Table 2 – Hormone levels in galactorrhic and amenorrhic patients Hormone level
Prolactin (2–15 ng/ml) LH FSH
Amenorrhoea
7
Amenorrhoea and galactorrhoea
Galactorrhoea
Normal
High
Normal
High
Normal
18 23 22
6 1 2
0 5 5
5 0 0
0 1 0
High 1 0 1
Table 3 – Demographics of adult female patients with and without galactorrhea out of 30 patients with galactorrhea/ amenorrhea With galactorrhea
Without galactorrhea
P-Value
27.58 9.757 23 (95.83%) 43.95 9.43 34.04 10.96
0.1079 0.8548 0.3313 0.8703
Not Not Not Not
Body area having burn (no. of patients) Head 4 (66.67%) Neck 2 (33.33%) Chest 30 (100%) Upper limbs 5 (83.33%) Lower limbs 1 (16.67%) Abdomen 2 (33.33%)
13 15 0 18 11 12
0.5805 0.1972
Not significant Not significant
0.666 0.4017 0.4642
Not significant Not significant Not significant
Chest burn representing % TBSA Post-ovulatory burn Multipara Obese
13.75 0.944 7 (29.17%) 17 (70.83%) 1 (0.042%)
0.0882 0.9178 0.1709
Not significant Not significant Not significant
Age Fertile age group TBSA% LOS
a b
a
35 9.899 5 (83.33%)b 40 4.472 33.16 14.63
13.66 0.516 4 (66.67%) 5 (83.33%) 2 (33.33%)
(54.16%) (62.5%) (0%) (75%) (45.83%) (50%)
Statistical significance significant significant significant significant
Mean value standard deviation (S.D.). Number of patients (% of patients).
galactorrhic patients had definite increase in the level of prolactin (P < 0.0001, statistically significant) (Table 4). Amenorrhoic patients were not offered any treatment except for reassurance. All galactorrhic patients (6) were treated with bromocriptine. Out of six, two patients had complete relief of symptom following treatment, two patients had reduction of secretion and two patients who did not follow up were possibly relieved. There was reduction in prolactin level after treatment, but it was not found to be statistically significant (Table 5).
4.
Discussion
Detection of galactorrhea and/or amenorrhea in 30 patients in a 6-month period suggests that this occurs with significant
frequency in after burn. But, surprisingly, this is not mentioned commonly in the available literature possibly because most of the patients do not reveal these symptoms to their treating physicians unless interrogated specifically. Most of the patients were in fertile age groups (93.33%) and all had suffered chest burns. Data from our unit shows that about 70 % of our female burn patients suffer from injury involving upper, anterior chest wall. The parity of the patient did not have any co-relation in our study group. In our study group, there was significant co-relation between amenorrhea–galactorrhea and chest, abdomen and upper limb burns (Table 1). There was significant co-relation with length of stay and amenorrhea–galactorrhea (Table 1). Earlier reports of galactorrhea in burned patients had associated this problem with obesity [2], etc. The possible
Table 4 – Hormonal level in blood of adult female patients with and without galactorrhea out of 30 patients with galactorrhea/amenorrhea With galactorrhea a
LH (mIU/ml) FSHc (mIU/ml) Prolactin (ng/ml) a b c
b
3.8 1.2198 5.96 4.639 58.66 41.826
Leutinizing hormone. Mean standard deviation (S.D.). Follicle stimulating hormone.
Without galactorrhea
P-Value
8.68 17.429 10.42 8.323 9.379 5.0279
0.5043 0.2209 <0.0001
Statistical significance Not significant Not significant Significant
828
burns 34 (2008) 825–828
Table 5 – Hormonal level in blood of adult female patients with galactorrhea prior and after medication Prior to medication (6) a
LH (mIU/ml) FSHc (mIU/ml) Prolactin (ng/ml) a b c
After medication (4)
P-Value
5.05 1.226 10.25 5.315 15.625 2.136
0.1517 0.2129 0.0787
b
3.8 1.2198 5.96 4.639 58.66 41.826
Statistical significance Not significant Not significant Not significant
Leutinizing hormone. Mean standard deviation (S.D.). Follicle stimulating hormone.
explanation for this occurrence has been suggested to be neurogenic in origin. Various causes of galactorrhea include chest surgery, burns and herpes zoster that affect the chest wall [1,3–5]. Burn causes wounds and scars which are hypersensitive and the stimuli are thought to pass along intercostal nerves to the posterior column of the spinal cord, to the mesencephalon and finally to the hypothalamus, which is responsible for the release of the prolactin inhibiting factor. Neurogenic stimulation probably suppresses the secretion of hypothalamic prolactin inhibiting factor, which results into hyperprolactinaemia leading to galactorrhea [1,5]. Ovadia et al., advocated use of intercostal nerve block for galactorrhea and amenorrhea due to chest burns [6]. However, there is no other evidence to support the utility of intercostal nerve block. Chronic emotional stress may be a neurogenic cause of galactorrhea [1]. In this series, none of the patients had received H-2 blockers or proton pump inhibitors, anti-hypertensive or antipsychotic drugs during the hospital stay. In our study group of 30 patients with amenorrhea– galactorrhea, we did not find any significant difference among patients with or without galactorrhea (Table 3). Amenorrhea may be related to stress caused by the injury leading to aberration affecting preovulation phase of the cycle. In our study all the women in the post-ovulation phase at the time of injury had one normal cycle of menses, but those in preovulatory phase became amenorrhic from the same cycle. Problems associated with galactorrhea are grossly distressing and disabling. The complain of breast leaking in these patients affected their social life adversely. All the patients in our series had either high normal or high levels of prolactin. These patients can be treated with bromocriptine, which is dopamine agonist and increases the level of PIH (prolactin inhibiting factor) in the hypothalamus thereby decreasing the level of prolactin. Other dopamine agonists such as cabergolin has now become available in India and our experience of its use in two patients outside this study is extremely encouraging. However, our study group is small. Large scale double blinded studies are indicated.
5.
Conclusion
The incidence of amenohrrea and/or galactorrhea was found to be 15.15% while incidence of galactorrhea was found to be 3.03% among burned women. The factors associated with higher risk of development of these symptoms were identified as (1) burn wound involving chest wall, abdomen and upper limbs. (2) Hospital length of stay. No association was noticed between parity, ovulation, obesity or medication. All women having chest burns should be specifically asked about complains of galactorrhea and amenorrhoea in postburn period and these distressing symptoms can be effectively treated with a dopamine agonist.
Conflict of interest None.
references
[1] Alexander KCL, Daniele P. Diagnosis and management of galactorrhea. Am Fam Phys 2004;70(3):543–50. [2] Hemant S. Postburn galactorrhea with refractory hypertrophic scars: role of obesity under scrutiny. J Burn Care Rehab 2003;24(November/December (6)):392–4. [3] Morley JE, Dawson M, Hodgkinson H, Kall WJ. Galactorrhea and hyperprolactinemia associated chest injury. J Clin Endocrinol Metabol 1977;November (45)(5):931–5. [4] Macfarlane IA, Rosin MD. Galactorrhea following surgical procedures to the chest wall: the role of prolactin. Post Grad Med J 1980;56(January (651)):23–5. [5] Pena KS, Rosenfield JA. Evaluation and treatment of galactorrhea. Am Fam Phys 2001;63(70):1763–75. [6] Ovadia J, Tadir Y, Jeel-Cohen J. Intercostal block for galactorrhea amenorrhea syndrome due to chest burn. Harefuah 1978;95(October (8)):256–7.
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Galactorrhea and amenorrhea in burn patients Navin Goyal *, Madhuri A. Gore, Ravi Shankar Department of General Surgery, L.T.M. Medical College, Sion, Mumbai 400022, India
article info
abstract
Article history:
Introduction: Galactorrhea and/or amenorrhea, although uncommonly reported in post-
Accepted 4 December 2007
burn patients, is a complex problem to treat. Patient is reluctant to volunteer history of these symptoms, unless asked specifically.
Keywords:
Aim: To study profile of adult female patients with galactorrhea and/or amenorrhea in post
Burns
burn period.
Galactorrhea
Materials and Method: A prospective study of all adult female patients presenting with or
Amenorrhea
detected to have galactorrhea and/or amenorrhea in post burn period was conducted over 6
Prolactin
month’s period. Detailed clinical examination, estimation of LH, FSH, Prolactin levels and Xray of skull was done in all patients. The data collected was analyzed. Patients with hyperprolactinemia and galactorrhea were treated with Bromocriptine for 3 weeks to 3 months. In all patients with amenorrhea, pregnancy was ruled out by gynecological examination and urine pregnancy test. Results: During this period, 30 patients (15.15%) were detected to have galactorrhea and/or amenorrhoea. The extent of burn in these patients was 20–65%of body surface area. Out of 30 patients, 5 had galactorrhea and amenorrhea, 1 galactorrhea alone and 24 had amenorrhea alone. Analysis of voluntary disclosures and detection on interrogation was done. Till the end of study, 4 patients with galactorrhea had complete relief, 2 patients reported reduction in discharge. Discussion: Galactorrhea was distressing for all and was always associated with high prolactine levels .The reverse was not true. All the patients had chest burns besides other body areas. Association was noted between menstrual aberration and ovulatory phase at the time of burn. Conclusion: Galactorrhea and menstrual disturbances do exist in female patients in reproductive age group in post burn period and patients should be especially interrogated for these symptoms by the burn care providers. # 2007 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Galactorrhea is defined as discharge of milk or milk-like secretion from the breast in the absence of parturition or beyond 6 months post-partum in non-breast feeding woman [1]. Post-burn galactorrhea, although relatively uncommon, is a complex problem to treat. Although the problem is itself very disabling and distressing for the patient, generally the patient is reluctant to divulge it to the treating physician either due to
inhibitions or because they do not link this problem to the burn injury.
2.
Materials and methods
It was a prospective study of all adult female patients with burn injury presenting with or detected to have galactorrhea or amenorrhea during 6-month period from February 2006 to
* Corresponding author. Tel.: +91 9999005756. E-mail addresses: [email protected] (N. Goyal), [email protected] (M.A. Gore), [email protected] (R. Shankar). 0305-4179/$34.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.12.001
826
burns 34 (2008) 825–828
Fig. 1 – Lay-out of patients.
July 2006. All patients were clinically examined and pregnancy was ruled out by gynecological examination and urine pregnancy test. Estimation of leutinising hormone (LH), follicle stimulating hormone (FSH) and prolactin levels was done at nuclear medicine department. X-ray of skull was taken in all patients. We did not examine thyroid hormone levels. All the galactorrhic patients with high levels of prolactin were treated with bromocriptine starting with 2.5 mg twice daily dose, which was increased upto 2.5–5 mg TDS till the symptoms were relieved. It was then continued in dosage of 2.5 mg thrice daily for 3 weeks and stopped.
3.
Results
In total 283 patients (198 women, 40 men and 45 children) visited to burns unit during study period. Out of 198 adult female patients, total 30 patients (15.15%) were found to have galactorrhea and/or amenorrhea (Fig. 1). The incidence of amenorrhea and/or galactorrhea was 15.15% in adult females while incidence of galactorrhea was 3.03%. Out of 30 women studied, only one patient volunteered her complaint to the clinician. In remaining 29 patients, the
condition was revealed by the patient on direct questioning and presence of galactorrhea was confirmed on clinical examination. Six patients had galactorrhea and 29 had amenorrhea (five had both amenorrhea and galactorrhea). Most of the women (93.33%) were in the fertile age group (16–45) with the median age of 28 years. Extent of burn ranged from 20% to 65% of body surface area with the majority having burn extent between 40% and 60%. All the patients had sustained chest wall burns (Table 1). Skull X-ray was normal in all patients. All patients in preovulation phase (18) at the time of injury continued to have amenorrhea after the injury but all in the post-ovulation phase (11) had one episode of menstrual flow after the burn injury and then had amenorrhea. In patients with galactorrhea, the symptom appeared between 2 and 5 months after-burns, with median period of 93 days. Out of 29 amenorrhic patient 5 were nulliparous, 2 primiparous and 22 multiparous. However out of 6 galactorrhic patients 5 were multiparous and 1 was primiparous (Table 2). None of the patients with amenorrhea was found to be pregnant on evaluation by the gynaecologist/obstetrician. As shown in Tables 3 and 4, no specific alteration of hormonal levels was detected in amenorrhic patients. But
Table 1 – Demographics of adult female patients with and without amenorrhea and/or galactorrhea
Age Fertile age group TBSA%c LOSd
With amenorrhea and/or galactorrhea
Without amenorrhea and/or galactorrhea
29.06 10.075a 28 (93.33%)b 43.16 8.757 33.86 11.509
28.28 12.069 144 (85.71%) 41.85 15.39 23.33 15.343
0.7371 0.2551 0.6515 0.0004
Not significant Not significant Not significant Significant
87 120 141 153 84 111
0.243 0.1067
Not significant Not significant
0.0207 0.3127 0.0424
Significant Not significant Significant
Body area having burn (no. of patients) Head 17 (56.67%) Neck 17 (56.67%) Chest 30 (15.15%) Upper limbs 23 (76.67%) Lower limbs 12 (40%) Abdomen 14 (46.67%) Chest burn representing % TBSA a b c d
13.73 0.868
Mean value standard deviation (S.D.). Number of patients (% of patients). Total body surface area %. Hospital length of stay.
(51.78%) (71.42%) (83.92%) (91.07%) (50%) (66.07%)
9.72 5.044
P-Value
<0.0001
Statistical significance
Significant
827
burns 34 (2008) 825–828
Table 2 – Hormone levels in galactorrhic and amenorrhic patients Hormone level
Prolactin (2–15 ng/ml) LH FSH
Amenorrhoea
7
Amenorrhoea and galactorrhoea
Galactorrhoea
Normal
High
Normal
High
Normal
18 23 22
6 1 2
0 5 5
5 0 0
0 1 0
High 1 0 1
Table 3 – Demographics of adult female patients with and without galactorrhea out of 30 patients with galactorrhea/ amenorrhea With galactorrhea
Without galactorrhea
P-Value
27.58 9.757 23 (95.83%) 43.95 9.43 34.04 10.96
0.1079 0.8548 0.3313 0.8703
Not Not Not Not
Body area having burn (no. of patients) Head 4 (66.67%) Neck 2 (33.33%) Chest 30 (100%) Upper limbs 5 (83.33%) Lower limbs 1 (16.67%) Abdomen 2 (33.33%)
13 15 0 18 11 12
0.5805 0.1972
Not significant Not significant
0.666 0.4017 0.4642
Not significant Not significant Not significant
Chest burn representing % TBSA Post-ovulatory burn Multipara Obese
13.75 0.944 7 (29.17%) 17 (70.83%) 1 (0.042%)
0.0882 0.9178 0.1709
Not significant Not significant Not significant
Age Fertile age group TBSA% LOS
a b
a
35 9.899 5 (83.33%)b 40 4.472 33.16 14.63
13.66 0.516 4 (66.67%) 5 (83.33%) 2 (33.33%)
(54.16%) (62.5%) (0%) (75%) (45.83%) (50%)
Statistical significance significant significant significant significant
Mean value standard deviation (S.D.). Number of patients (% of patients).
galactorrhic patients had definite increase in the level of prolactin (P < 0.0001, statistically significant) (Table 4). Amenorrhoic patients were not offered any treatment except for reassurance. All galactorrhic patients (6) were treated with bromocriptine. Out of six, two patients had complete relief of symptom following treatment, two patients had reduction of secretion and two patients who did not follow up were possibly relieved. There was reduction in prolactin level after treatment, but it was not found to be statistically significant (Table 5).
4.
Discussion
Detection of galactorrhea and/or amenorrhea in 30 patients in a 6-month period suggests that this occurs with significant
frequency in after burn. But, surprisingly, this is not mentioned commonly in the available literature possibly because most of the patients do not reveal these symptoms to their treating physicians unless interrogated specifically. Most of the patients were in fertile age groups (93.33%) and all had suffered chest burns. Data from our unit shows that about 70 % of our female burn patients suffer from injury involving upper, anterior chest wall. The parity of the patient did not have any co-relation in our study group. In our study group, there was significant co-relation between amenorrhea–galactorrhea and chest, abdomen and upper limb burns (Table 1). There was significant co-relation with length of stay and amenorrhea–galactorrhea (Table 1). Earlier reports of galactorrhea in burned patients had associated this problem with obesity [2], etc. The possible
Table 4 – Hormonal level in blood of adult female patients with and without galactorrhea out of 30 patients with galactorrhea/amenorrhea With galactorrhea a
LH (mIU/ml) FSHc (mIU/ml) Prolactin (ng/ml) a b c
b
3.8 1.2198 5.96 4.639 58.66 41.826
Leutinizing hormone. Mean standard deviation (S.D.). Follicle stimulating hormone.
Without galactorrhea
P-Value
8.68 17.429 10.42 8.323 9.379 5.0279
0.5043 0.2209 <0.0001
Statistical significance Not significant Not significant Significant
828
burns 34 (2008) 825–828
Table 5 – Hormonal level in blood of adult female patients with galactorrhea prior and after medication Prior to medication (6) a
LH (mIU/ml) FSHc (mIU/ml) Prolactin (ng/ml) a b c
After medication (4)
P-Value
5.05 1.226 10.25 5.315 15.625 2.136
0.1517 0.2129 0.0787
b
3.8 1.2198 5.96 4.639 58.66 41.826
Statistical significance Not significant Not significant Not significant
Leutinizing hormone. Mean standard deviation (S.D.). Follicle stimulating hormone.
explanation for this occurrence has been suggested to be neurogenic in origin. Various causes of galactorrhea include chest surgery, burns and herpes zoster that affect the chest wall [1,3–5]. Burn causes wounds and scars which are hypersensitive and the stimuli are thought to pass along intercostal nerves to the posterior column of the spinal cord, to the mesencephalon and finally to the hypothalamus, which is responsible for the release of the prolactin inhibiting factor. Neurogenic stimulation probably suppresses the secretion of hypothalamic prolactin inhibiting factor, which results into hyperprolactinaemia leading to galactorrhea [1,5]. Ovadia et al., advocated use of intercostal nerve block for galactorrhea and amenorrhea due to chest burns [6]. However, there is no other evidence to support the utility of intercostal nerve block. Chronic emotional stress may be a neurogenic cause of galactorrhea [1]. In this series, none of the patients had received H-2 blockers or proton pump inhibitors, anti-hypertensive or antipsychotic drugs during the hospital stay. In our study group of 30 patients with amenorrhea– galactorrhea, we did not find any significant difference among patients with or without galactorrhea (Table 3). Amenorrhea may be related to stress caused by the injury leading to aberration affecting preovulation phase of the cycle. In our study all the women in the post-ovulation phase at the time of injury had one normal cycle of menses, but those in preovulatory phase became amenorrhic from the same cycle. Problems associated with galactorrhea are grossly distressing and disabling. The complain of breast leaking in these patients affected their social life adversely. All the patients in our series had either high normal or high levels of prolactin. These patients can be treated with bromocriptine, which is dopamine agonist and increases the level of PIH (prolactin inhibiting factor) in the hypothalamus thereby decreasing the level of prolactin. Other dopamine agonists such as cabergolin has now become available in India and our experience of its use in two patients outside this study is extremely encouraging. However, our study group is small. Large scale double blinded studies are indicated.
5.
Conclusion
The incidence of amenohrrea and/or galactorrhea was found to be 15.15% while incidence of galactorrhea was found to be 3.03% among burned women. The factors associated with higher risk of development of these symptoms were identified as (1) burn wound involving chest wall, abdomen and upper limbs. (2) Hospital length of stay. No association was noticed between parity, ovulation, obesity or medication. All women having chest burns should be specifically asked about complains of galactorrhea and amenorrhoea in postburn period and these distressing symptoms can be effectively treated with a dopamine agonist.
Conflict of interest None.
references
[1] Alexander KCL, Daniele P. Diagnosis and management of galactorrhea. Am Fam Phys 2004;70(3):543–50. [2] Hemant S. Postburn galactorrhea with refractory hypertrophic scars: role of obesity under scrutiny. J Burn Care Rehab 2003;24(November/December (6)):392–4. [3] Morley JE, Dawson M, Hodgkinson H, Kall WJ. Galactorrhea and hyperprolactinemia associated chest injury. J Clin Endocrinol Metabol 1977;November (45)(5):931–5. [4] Macfarlane IA, Rosin MD. Galactorrhea following surgical procedures to the chest wall: the role of prolactin. Post Grad Med J 1980;56(January (651)):23–5. [5] Pena KS, Rosenfield JA. Evaluation and treatment of galactorrhea. Am Fam Phys 2001;63(70):1763–75. [6] Ovadia J, Tadir Y, Jeel-Cohen J. Intercostal block for galactorrhea amenorrhea syndrome due to chest burn. Harefuah 1978;95(October (8)):256–7.