Galactorrhea may be a sign of Chiari-Frommel syndrome

Chiari-Frommel syndrome is a syndrome of persistent lactation and amenorrhea, which is combined with atrophic changes in the genitals. Functional disorders can occur after the use of tranquilizers in high doses, mental trauma, removal of the uterus, during false pregnancy and in the postpartum period. The cause of this syndrome has not yet been fully elucidated. What are the probable causes and mechanism of development of the Chiari syndrome – Frommel? What are the symptoms and treatment of this syndrome, read further on estet-portal.com.

Mechanism of development of Chiari-Frommel syndrome

There are two theories of the occurrence of the Chiari-Frommel syndrome. According to the first, its cause is a tumor pituitary. Proponents of the tumor genesis of the syndrome note that neoplasms are often detected much later than the first clinical manifestations. There are data on observations when the tumor was diagnosed 6 or even 15 years after the onset of the disease. According to the second theory, the disease is caused by dysfunction of the pituitary gland.

The development of Chiari-Frommel syndrome is based on damage to the centers of the hypothalamus, which regulate the synthesis of releasing hormone, which suppresses the formation of hormoneprolactin, which increases the secretion of lactotropic hormone.

In turn, prolonged circulation of high doses of lactotropic hormone suppresses the production of follicle-stimulating hormone, which leads to a decrease in the secretion of estrogen by the ovaries and, as a result, to amenorrhea.

Clinical picture and symptoms of Chiari-Frommel syndrome

The disease manifests itself most often after childbirth. In most patients, the previous pregnancy proceeded pathologically (late preeclampsia, septic complications, bleeding, notes estet-portal.com. Chiari – Frommel's syndrome can be combined with obesity with an even distribution of adipose tissue, mental disorders, damage to the hypothalamus. Inhibition of the diencephalon by 50% leads to hypersecretion of prolactin and a decrease or complete delay in the production of follicle-stimulating hormone.

 The main symptoms of Chiari-Frommel syndrome are:

• headache;
• malaise;
• impaired vision;
• excessive milk flow (not associated with breastfeeding);
• absence of menses;
• enlargement of breast;
• areolar pigmentation absent;
• there are atrophic changes in the vagina (vulva), cervix and body of the uterus.

Diagnosis and treatment of Chiari-Frommel syndrome

For the diagnosis of Chiari-Frommel syndrome, it is necessary to take an anamnesis, conduct a general clinical, gynecological and endocrinological examination. It is also necessary to consult an ophthalmologist (determination of visual acuity and fields, X-ray examination of the skull (frontal and lateral images of the Turkish saddle with tomography). If signs of a tumor are detected, a consultation with a neurosurgeon.

Hormonal studies reveal an increased concentration of prolactin (200 MO per l), a decrease in the level of gonadotropins (LH and FSH), estradiol (lower limit of normal), a normal concentration of 17-KS.

In the presence of a tumor, surgical treatment or radiation therapy, telegammatherapy is indicated. The main drugs for pharmacotherapy are ergotine derivatives - dopamine agonists.

There are three generations of drugs:

1 generation - ergotine and its derivatives: bromocriptine, lisuride. "gold standard" for the treatment of hyperprolactinemia is bromocriptine.

2nd generation – ergotine-free dopaminomimetics (norprolac).

3rd generation - dopaminergic derivative of ergotine - cabergoline (Dostinex). The dose of dostinex is calculated according to the formula: the number of tablets of the drug per week corresponds to the multiplicity of the increase in prolactin relative to the upper limit of the norm (according to the laboratory in which the study is carried out).

Criteria for the effectiveness of therapy for Chiari-Frommel syndrome:

• normalization of the level of prolactin in the blood serum;
• restoration of the menstrual cycle;
• cessation of galactorrhea;
• reduction in the size of adenoma in case of tumor genesis of the disease.

Thus, if a woman detects the above symptoms, it is urgent to contact an endocrinologist and gynecologist for the diagnosis and treatment of Chiari syndrome – Frommel.