Hyperprolactinemia; Prolactinoma; Pituitary Adenoma

Hypergalactia or hyperlactation is the excessive production of breast milk, with a volume greater than that necessary for the infant to grow normally. There may be physical and social discomfort, fullness and pain in the breast, frequent milk leakage, duct obstruction, vasospasm and mastitis. Infants may have choking, breast refusal, excessive weight gain or weight loss.... All of these can lead to cessation of lactation.

The causes of hypergalactia can be due to hyperstimulation of the breast, idiopathic (of unknown cause) or due to hyperprolactinemia, whether or not due to prolactinomas.

There is no good quality evidence on the best treatment of hypergalactinemia. The following progressive actions are recommended in a stepwise fashion. ^{(Johnson 2020, Trimeloni 2016)}:

1. Make milk let-down more difficult: breastfeed supine (face up); use nipple shields.
2. Avoid hyperstimulation (caused by pumping and/or very frequent feedings) by breastfeeding from one breast alternating with the other in hourly blocks of 3 to 6 hours (block feeding). ^{(van Veldhuizen 2007)}
3. Avoid taking pharmacological or herbal galactogogues (domperidone, metoclopramide, sulpiride, fenugreek...), 
4. Take infusions of various plants traditionally prescribed to reduce milk production such as peppermint, sage, parsley, jasmine flowers, chasteberry.
5. Taking medications that can decrease milk production, such as Pseudoephedrine 30 to 60 mg once or twice a day or combined contraceptives containing at least 20 mg of estradiol.
6. Take dopaminergic medication that inhibits prolactin: 
   1. Cabergoline 0.25 mg, repeating after 3 days if no improvement; can be increased to 0.5 mg after 3 days 
   2. Bromocriptine 0.25 mg per day for 3 days.

HYPERPROLACTINEMIA and PROLACTINOMES

Breastfeeding does not pose a risk of prolactinoma growth, nor does it increase the recurrence of hyperprolactinemia, whether or not due to micro or macro prolactinomas ^{(Aguayo 2014, Auriemma 2013, Shahzad 2012, Bronstein 2005)}. Remission of prolactinomas after pregnancy and lactation is frequent ^{(Domingue 2014)}. There is consensus from expert societies that prolactinomas, micro or macro, do not contraindicate breastfeeding ^{(Casanueva 2006)}. If they give compression symptomatology they can be treated with dopaminergic agonists. ^{(Aguayo 2014)}

Successful and prolonged lactation has been described in more than 30 cases of hypergalactia-prolactinoma-hyperprolactinemia treated with a daily dose of 2.5 to 5 mg of bromocriptine without adverse effects in the infants. ^{(Liu 2018, Verma 2006, Cheng 1996, Canales 1981, Peters 1985)}