Decreased milk production

Introduction The reduction in milk secretion is mainly seen in anterior pituitary dysfunction, such as pituitary necrosis or infarction and postoperative surgery for pituitary diseases. Especially Sheehan's disease is the most important. Rich in nutrition, maintain good health; can not fatigue, adequate sleep, regular life; comfortable, happy spirit; breastfeeding method can be very good for the baby, the milk in the breast is often empty, the milk is more and more. Milk stasis is caused by the poor discharge of milk from a gland leaf during lactation, resulting in the accumulation of milk in the milk. The main clinical manifestation is the intratumoral mass, which is often misdiagnosed as a breast tumor.

Cause

Etiology classification

1. Postpartum pituitary necrosis and atrophy: It is easy to cause ischemia and necrosis when the pituitary is physiological hypertrophy during pregnancy, which may be an important condition for the occurrence of this disease. Secondly, the blood supply to the anterior pituitary is from the portal system. Major bleeding or infection can cause shock and DIC, which can cause microthrombus formation in the pituitary vessels, leading to tissue ischemic necrosis.

2. Pituitary tumor and pituitary tumor compression.

3. Injury such as surgery, radioactivity and other physical factors.

4. Infection or inflammation: such as tuberculosis, syphilis, fungi, meningitis caused by pyogenic bacteria and meningoencephalitis.

5. Brain surgery: Clinical symptoms may occur when the anterior pituitary is damaged by more than 50%.

6. Cerebrovascular disease: arteriosclerosis can cause pituitary necrosis; iliac arteritis, cavernous sinus thrombosis can cause pituitary ischemia.

7. Others: Hemophilia patients with excessive hemosiderin in the pituitary; and pituitary autoimmune diseases can cause this disease, but less common.

an examination

Related inspection

Chest MRI chest CT examination plasma auxin medium assay (SOM) breast ultrasound examination

(1) medical history

According to postpartum hemorrhage, serious infection and brain trauma, tumor, inflammation and other medical history.

(B) accompanied by the following performance of the surrounding target gland

1. Hypogonadism: amenorrhea.

2. Hypothyroidism: fear of cold, dry skin, slow response, slow movement, hoarseness and so on.

3. Decreased adrenal function: fatigue, loss of appetite, orthostatic hypotension, hypoglycemia, etc.

4. PRL deficiency: reduced milk or no milk secretion.

5. The skin is pale, body hair, mane and pubic hair are rare or absent, genital atrophy, bradycardia.

(C) The following symptoms of glandular hormones often appear in this disease

1. Pituitary hormone: serum GH, ACTH, PRL, FSH, LH, TSH, MSH (melanocyte stimulating hormone) water is low.

2. Thyroid hormone: total T3 (TT3, normal value is 1.23-3.08nmol/L), total T4 (TT3, normal value is 65156nmol/L) free T3 (FT3, normal value is 2.0-9.5SPmol/L) free T4 (FT4, the normal value is 9.5-25.5 pmol/L (normal value is l-10 mU/L, radioimmunoassay) is low.

3. Decreased levels of adrenocortical hormones, including

(1) Plasma cortisol: normal value 8:275.9+66.2 nmol/L at 4 am and 129+52.4 nmol/L/L at 4:00 pm. The disease is reduced.

(2) Urine 17-KS: normal adult, male 28.4-mol / d, female 20.8-34.6 mol / d decreased.

(3) urinary 17-OHCS: normal adult, male 25.1-41.3 mol / d, female 22.3-33.3 mol / d, the disease is reduced.

(4) urinary free cortisol: normal value is 206.9 + 44.1nmol / d, the disease is reduced.

(5) Gonadal hormone: blood and urine estradiol (E2 progesterone (P) level is low.

(6) Functional test

1ACTH stimulation test: ACTH 25U was dissolved in 5% glucose solution 500 ml intravenously for 8 hours, continuous for 2 days, before and after infusion, plasma cortisol and 24h urine 17-OHCS, 17-KS were detected respectively. Delayed response.

2 methadone (Su-885) test: take ketone 500-750mg, every 4 hi times, and even served 6 times, before and after the monthly drug test urine 17-0HCS. There was no significant increase in urinary 17-OHCS after taking the drug, suggesting that the ACTH reserve function was insufficient (for those suspected adrenal insufficiency and debilitation, the test was banned.

3TRH stimulation test: TSH, PRL or GH rise before and after intravenous injection of TRH 33g was not significant, which was helpful for the diagnosis of pituitary dysfunction (normal TSH rise >10 mU/L).

4 Gonadotropin Re-leasing Hormone (GnRh) stimulation test: FSH, LH levels did not increase significantly.

5 chlorpromazine test: chlorpromazine 25mg intramuscular injection, serum PRL did not increase significantly (normal people increased 2-3 times).

6 vaginal smear cytology: showing low hormone levels.

(4) X-ray, CT, MRI examination, brain tumors, etc. can be found.

Differential diagnosis

Milk stagnation, breast stones are mostly derived from milk. When a woman receives some kind of stimulation during lactation, it will cause the milk duct to be blocked, the milk is not smooth, or the milk pipeline may become narrow or completely blocked due to inflammation of the breast, causing milk stagnation. Excessive milk stored in the lobule of the breast forms a cyst of the breast. After a long time, the milk in the cyst is gradually absorbed, and after the calcium deposit, the breast stones are formed.

Milk stasis is caused by the poor discharge of milk from a gland leaf during lactation, resulting in the accumulation of milk in the milk. The main clinical manifestation is the intratumoral mass, which is often misdiagnosed as a breast tumor. The initial symptoms are usually breast masses, which are more common on one side. The peripheral part of the breast outside the areola area is round or elliptical. The boundary is clear, the surface is smooth, slightly active, and the cystic nature of the cyst is slightly tender. In 2~3cm, the lymph nodes are generally swollen in the innocent area. Young women find breasts with clear breast borders during or after breastfeeding, and complain that they have had mastitis during lactation.

The obstruction of the lactiferous duct, the inflammation of the milk duct itself, the tumor and external compression, and the loss of fibers from the bra can cause the milk to accumulate. The patient is consciously accumulating milk, local swelling and pain in the breast, agglomeration with or without, accompanied by tenderness, and imaging diagnosis can be diagnosed.

Postpartum liver qi stagnation is characterized by very little milk secretion, accompanied by chest rib swelling, breast pain, depression, or depression, or low heat, thin yellow tongue coating. Baobao is still crying after eating breast milk. The small mouth is still looking for it and needs to feed the milk powder.

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