We thank our colleagues for their practical contributions, which reflect the great interest in the topic presented (1). In the following, we would like to address some of the points mentioned.
We fully agree with our colleagues that the S3 Guideline “Treatment of Inflammatory Breast Disease during the Lactation Period” gives a very good summary of the subject. This therefore forms the basis of our article and is sufficiently quoted (reference 33 in the article) (2). We noted that milk stasis can be a differential diagnosis of puerperal mastitis. Massaging the blocked areas of a breast with milk stasis or mastitis is given as a consensus point in the above-mentioned S3 guideline. We are grateful for the indication of the additional antiphlogistic effect of ibuprofen, which makes this a drug of first choice for pain relief. The good analgesic and antipyretic effects of paracetamol remain undisputed. As mentioned, secondary weaning should only be carried out in the case of protracted illness and at the express wish of the patient. According to a report in the Cochrane Database that compared bromocriptine with non-pharmacological measures for lactation suppression, bromocriptine significantly reduced the proportion of women lactating as compared to the control group (n = 107, relative risk 0.36, 95% confidence interval [0.24, 0.54]) (3). However, following a benefit-risk assessment by the European Medicines Agency (EMA) and the German Federal Institute for Drugs and Medical Devices (BfArM, Bundesinstitut für Arzneimittel und Medizinprodukte) in 2014, prescription of bromocriptine requires a clear indication, as serious adverse effects can occur in rare cases; for instance, hypertension, myocardial infarction, seizures, or stroke have been reported (www.bfarm.de) (4).
We thank our colleagues from ophthalmology for their valuable reference to the need for ophthalmological evaluation in the presence of a prolactinoma. Nevertheless, for stage diagnosis, a magnetic resonance tomography should initially be carried out to assess the position and size of the prolactinoma. According to a current review on vision impairment in patients with pituitary adenomas, microadenomas (<1 cm) are not expected to influence vision, while macroprolactinomas present with visual impairment in 40–85% of cases, with a higher probability with large (>2 cm) or giant prolactinomas (>4 cm) (5). The basic diagnostics of ophthalmological evaluation prior to therapy include functional assessment of the optic nerve, examination of eye motility, slit-lamp examination, and optical coherence tomography (OCT). Controls by an ophthalmologist over the course of therapy are also important. An improvement in the visual field after treatment with dopamine agonists is expected for 67% of patients. The time span ranges from two weeks to six months. Rarely, as a result of an empty sella syndrome with herniation of the optic chiasm, deterioration of the visual field is observed. Interested ophthalmologists should refer the review, which is worth reading.
On behalf of the authors
PD. Dr. med. habil. Angrit Stachs
Universitätsfrauenklinik Rostock, Germany
Conflict of interest statement
The authors of the contributions declare that no conflict of interest exists.
|1.||Stachs A, Stubert J, Reimer T, Hartmann S: Benign breast disease in women. Dtsch Arztebl Int 2019; 116: 565–74 VOLLTEXT|
|2.||Jacobs A, Abou-Dakn M, Becker K, et al.: S3-Leitlinie „Therapie entzündlicher Brusterkrankungen in der Stillzeit“. Senologie – Zeitschrift für Mammadiagnostik und -therapie 2014; 11: 50–6 CrossRef|
|3.||Oladapo OT, Fawole B: Treatments for suppression of lactation. Cochrane Database Syst Rev 2012: CD005937 CrossRef PubMed Central|
|4.||BfArM: Rote-Hand-Brief zu bromocriptinhaltigen Arzneimitteln: Anwendungseinschränkung zur Hemmung der Milchbildung. BfArM 2014.|
|5.||Lithgow K, Batra R, Matthews T, Karavitaki N: Management of endocrine disease: Visual morbidity in patients with pituitary adenoma. Eur J Endocrinol 2019; [Epub ahead] CrossRef MEDLINE|