Gastroenterology

Interactive Quiz: Galactorrhea as the Initial Presentation of a Hepatic Condition

  • Due to the patient’s confounding risk factors for cirrhosis, it is hard to determine whether the resolution of symptoms after his HCV viral load had dropped below a detectable level was causal or coincidental. Moreover, his normal CT findings are insufficient to rule out the possibility of a prolactin-secreting microadenoma that may become structurally evident later in the natural history of the disease. The etiology remains unclear, and as far as we are aware, HCV has no molecular mimicry of prolactin or any ability to influence milk production. Moreover, Gilead Sciences, the manufacturer of Harvoni,23 was unable to provide an explanation for the resolution of our patient’s galactorrhea (written communication, March 23, 2017).

    We propose that this man’s galactorrhea might be explained by a combination of milk duct development through estradiol stimulation and milk production from the variable prolactin peptide model suggested by Agarwal and colleagues.22

    References:

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    23. Harvoni [package insert]. Foster City, CA: Gilead Sciences Inc: 2017.