Abstract
Abnormal lactation was observed in uremia female patients on regular dialysis treatment (RDT). Endocrinological studies were performed in these patients especially on serum Prolactin levels in comparison with uremic patients without abnormal lactation (N=120) and with normal controls (N=27) In 51 uremic females, 5 patients exhibited abnormal lactation not attributable to pregnancy, delivery and breast feeding (inappropriate lactation syndrome, ILS). Mean age of ILS patients was 37. The lactation appeared 5-18 years after her delivery as the progression of renal failure. Amenorrhea was observed in most of ILS patients during lactation period. Lactation showed progressive decrease in the course of RDT. High basal serum LH level in uremics (60.6±13.9mIU, N=15) was observed. LH response to LH-RH infusion was remarkaby disturbed in ILS patients and this response recovered in accordance with dinnunition of lactation and reappearance of regular menstruation cycle. Basal FSH levels were almost within normal range, while FSH response to LH-RH infusion was suppressed. Estradiol in amenorrheal and lactating patients was 28.5±7.9pg/ml and was significantly lower compared to uremic patients with normal cycle (143.3±32.3pg/ml, luteal phase). From these data, it can be suggested that there is a primary dysfunction of ovary in uremics, especially with ILS. Basal TSH levels were within normal range. TSH response to TRH infusion was remarkably disturbed in lactating period. Hypothalamo-pituitary dysfunction was also suspected. Serum prolactin levels (male : 36.0±3.2, female : 62.8±6.5ng/ml) of uremics were significantly higher than normal controls. Amenorrheal and ILS patients showed both significantly higher values than normal cycle uremic females. Long-term RDT and single hemodialysis showed no effects on serum prolactin levels, but slight reduction by single performance was observed in a few cases. The single dose administration TRH, L-dopa and CB-154 to ILS patients caused no changes on serum prolactin levels. Long-term medication with of CB-154 was only successful in diminishing lactation. In conclusion, hyperprolactinemia, and overian and hypothalamopituitary dysfunction can be regarded as common disorders in end stage renal failure, and as one of its manifestations, ILS appeared in uremic females.
