Failure of postpartum lactogenesis due to isolated prolactin deficiency

Abstract

Objective: To review a case of a postpartum female with lactation failure due to isolated prolactin deficiency.

Methods: We describe the presentation of isolated prolactin deficiency, found during the evaluation of a postpartum woman withabsence of postpartum lactogenesis.

Results: A 31-year-old G1P1 female five weeks post-partum presented for evaluation of lactation failure. She had an uncomplicatedpregnancy and delivery, with no retained placental fragments. The patient was unable to lactate despite regularbreast stimulation through early and regular infant latch and subsequent bilateral breast pumping. The patient had a historyof Hashimoto’s thyroiditis, but was otherwise healthy. There was no history of alcohol abuse or breast disease. A prolactinlevel measured after a session of breast pumping was 12.4 ng/ml (reference range 122-370 ng/ml). Evaluation of other pituitaryhormones was normal. An MRI of the pituitary was unremarkable.

Conclusion: Isolated prolactin deficiency is a rare disorder, presenting postpartum with lack of breast milk production. The causeof this condition is unclear, but may be related to autoimmune destruction of lactotrophs in some patients. In the future, treatmentwith recombinant human prolactin may be used to treat this rare disorder.