Association between Hyperprolactinemia and Granulomatous Mastitis.

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Granulomatous mastitis (GM) is an uncommon inflammatory breast condition with various potential causes.
• While often linked to pregnancy and lactation, a subset of GM cases are associated with hyperprolactinemia, stemming from medications or intracranial lesions like pituitary adenomas.

Observation:

• This study reviewed literature and identified four cases of GM co-occurring with hyperprolactinemia at Cleveland Clinic Florida.
• Two cases involved prolactin-secreting pituitary adenomas, and a third had a craniopharyngioma causing elevated prolactin via dopamine transport disruption.
• The fourth patient also had a history of elevated prolactin.

Findings:

• All four patients exhibited classical histopathological features of GM, including noncaseating granulomas and multinucleated giant cells.
• Surgical removal of a craniopharyngioma in one patient led to the resolution of breast lesions and normalized prolactin levels.
• This suggests a potential direct causal link between intracranial lesion-induced hyperprolactinemia and GM.

Implications:

• The findings suggest that hyperprolactinemia secondary to intracranial lesions may be a direct cause of granulomatous mastitis.
• Screening for pituitary tumors and assessing prolactin levels are recommended in the workup of GM patients lacking typical risk factors like recent lactation or pregnancy.
• This approach may improve diagnostic accuracy and patient management for this rare breast condition.