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  #1  
Old 01-30-2011
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Question Prolactin and gynecomastia

1- Is prolactin capable of causing gynecomastia?
2- what exactly prolactin does? does it stimulate glandular cells of breast to make milk or does it increase those cells?

I remember from Goljan lectures - if i am not mistaking- he said men do not have glandular tissue so high prolactin in them does not cause galactorrhea (something like that)
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Old 01-30-2011
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Arrow Concepts

Yes prolactin can cause galactorrhea and gynecomastia because it stimulates the mammary glands to produce milk and also it causes breat tissue hyperplasia.

There's something called Neonatal Milk or Witch's Milk, this is a condition seen in newborn infants (males and females) due to exposure to placentally transferred maternal prolactin.

One of the most common clinical features of prolactinoma in males is the development of gynecomstia.

Males are less likely to develop galactorrhea (although they can) not because they don't gave glandular tissue, but because they don't have enough estrogen which is needed to prime the breast tissue before prolactin can work.
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Old 01-30-2011
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Hokolesqua is absolutely right.

Both Prolactin and Estrogens are needed for development of breast tissue, even though too much estrogen blocks lactogenesis.


Hyperprolactinemia in men often causes gynecomastia as one of thoses hypogonadism signs, such as sexual problems, decreased libido, muscular hypotrophy etc.


Actually, men are able to produce milk because we have breast tissue. We can even have breast cancer, indeed. In spite of that, breast development is dependent not just of prolactin, but also of estrogen, so that it's not a very sensitive sign of hyperprolactinemia.


Prolactin stimulates acinar cells to secrete - not eject - milk. More milk is secreted through a neural arc that stimulates even more these cells. Ejection is made based on neuroendocrin reflex of succion inducing ocitocin release, which induces contraction on mioepithelial cells that "embrace" the acinum.



Sorry for any english mistakes. I hope I helped you.
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Old 01-31-2011
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I had to double check with th book.
@hokolesqua;
you said "Males are less likely to develop galactorrhea (although they can) not because they don't gave glandular tissue, but because they don't have enough estrogen which is needed to prime the breast tissue before prolactin can work. "

Goljan book says why no galactorrhea in male "not enough estrogen -dependent TISSUE to produce galactorrhea" it does not say not enough ESTROGEN.
but i also know about neonatal milk which i assume happens in both MALE and female neonates. then WHY Goljan says no galactorrhea in male?
my book 3th edition,p;479
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Old 01-31-2011
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Quote:
Originally Posted by hana View Post
I had to double check with th book.
@hokolesqua;
you said "Males are less likely to develop galactorrhea (although they can) not because they don't gave glandular tissue, but because they don't have enough estrogen which is needed to prime the breast tissue before prolactin can work." Goljan book says why no galactorrhea in male "not enough estrogen -dependent TISSUE to produce galactorrhea" it does not say not enough ESTROGEN.
I think they are saying the same thing - Goljan does not say whether he is describing the existence or character of the tissue. Surely for our level of understanding either way of thinking about it sufficient.

Quote:
Originally Posted by hana View Post
but i also know about neonatal milk which i assume happens in both MALE and female neonates. then WHY Goljan says no galactorrhea in male?
my book 3th edition,p;479
Babies of both sexes are exposed to maternal estrogen, so both could have neonatal galactorrhea. In adults, only women would have had the necessary estrogen influence to develop lactating tissue.

(for further reading about galactorrhea, there's a fine review here.)
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Arrow Goljan can have mistakes

Quote:
Originally Posted by hana View Post
then WHY Goljan says no galactorrhea in male?
my book 3th edition,p;479
Well, Goljan is not always right. In every book you find errors.
Search the literature and the internet and wherever you want and you'll see that MEN do have glandular breast tissue, it's just rudimentary because of the lack of female sex hormones. In hyperprolactinemia (in men) that breast tissue get stimulated and milk production can occur, though much less frequently than in the case of women.
By the way, the definition of Galactorrhea is: Breast milk production in non-pregnant females or males.
Also in this MedScape article you find this sentence "Galactorrhea is much less common in men than it is in women, and demonstrating galactorrhea in a male may require vigorous breast manipulation."
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Old 01-31-2011
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Quote:
Originally Posted by Hokolesqua View Post
Well, Goljan is not always right...
Yeah - Goljan tries to keep it simple, too, so it's high-yield. I wouldn't take what he writes as exclusionary of other things; rather, he is summarizing the most applicable knowledge.
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Old 02-01-2011
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So I can conclude that we can get more milk in chronic alcoholic men who has a prolactinoma. Because they will have more estrogen due decreased metabolism in the liver. Other group is overweighted men with prolactinoma due to increase cortisol level (increase aromatase).
Isn't it?
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Old 05-09-2011
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I'd like to add that men get breast cancer because most breast cancers originate in the ducts of the gland, which are equal in number in both males and females.
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