Correspondence

Nipple Piercing and Hyperprolactinemia

N Engl J Med 2002; 347:1626-1627November 14, 2002

Article

To the Editor:

A healthy 20-year-old woman presented with breast pain and bilateral purulent nipple discharge three weeks after having her nipples pierced. She received a course of antibiotics (cephalexin), and her infection resolved. Two weeks later, she returned because of bilateral spontaneous galactorrhea. Evaluation at that time showed a prolactin level of 218 μg per liter, with a negative urine test for pregnancy and normal concentrations of serum thyrotropin (0.22 μU per milliliter), blood urea nitrogen (8 mg per deciliter [2.9 mmol per liter]), and serum creatinine (0.6 mg per deciliter [53 μmol per liter]). Three weeks later, the patient noted a decrease in galactorrhea; her prolactin level was 82.7 μg per liter. Two months later, she became pregnant and had an uneventful termination of the pregnancy. Her menses remained normal throughout this time, except during the pregnancy. Two months after the pregnancy, she had the nipple rings removed, and she has had no further galactorrhea. By a month after the removal of the rings, her prolactin level had returned to normal, at 11.3 μg per liter. Since cephalexin therapy was completed, the patient has not received any medications. Magnetic resonance imaging of the pituitary was normal.

This young woman had a dramatic increase in prolactin and associated galactorrhea that coincided with the placement of bilateral nipple rings. Harrison's Principles of Internal Medicine 1 notes that hyperprolactinemia in which the prolactin level is greater than 100 μg per liter “almost invariably is indicative of a prolactin-secreting pituitary adenoma.” Williams Textbook of Endocrinology 2 comments that “a single prolactin measurement may be sufficient to diagnose a prolactinoma if the value is greater than 200 μg [per liter].” The online version of UpToDate 3 notes that serum prolactin concentrations “may increase slightly,” reaching the range of 21 to 40 μg per liter, with “intense breast stimulation” and that serum prolactin values above 200 μg per liter “usually indicate the presence of a lactotroph adenoma.” In an older study,4 nipple stimulation did not elevate serum prolactin levels in nonlactating women. Other studies have shown lower levels of hyperprolactinemia (less than four times the upper limit of normal) even with the intense stimulation of afferent pathways from severe chest burns or rib fracture or immediately after thoracotomy.5 In the case we report, marked hyperprolactinemia (prolactin level, >200 μg per liter) was associated with the intense stimulation of nipple rings (probably with the added stimulation of the associated infections), and the prolactin level returned to normal with removal of the rings.

Geoffrey A. Modest, M.D.
Boston University School of Medicine, Boston, MA 02118
gmodest@partners.org

John J.W. Fangman, M.D.
Harvard Medical School, Boston, MA 02115

5 References

1. 1

   Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's principles of internal medicine. 15th ed. Vol. 2. New York: McGraw-Hill, 2001:2039.
   

2. 2

   Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams textbook of endocrinology. 9th ed. Philadelphia: W.B. Saunders, 1998:289.
   

3. 3

   Snyder PJ. Clinical manifestations and diagnosis of hyperprolactinemia. In: UpToDate in medicine. Wellesley, Mass.: BDR-UpToDate, September 10, 2001. (Also available at http://uptodateonline.com/.)
   

4. 4

   Jarrell J, Franks S, McInnes R, et al. Breast examination does not elevate serum prolactin. Fertil Steril 1980;33:49-51
   Web of Science | Medline

5. 5

   MacFarlane IA, Rosin MD. Galactorrhea following surgical procedures to the chest wall: the role of prolactin. Postgrad Med J 1980;56:23-25
   CrossRef | Web of Science | Medline

Citing Articles (11)

Citing Articles

1. 1

   Jaimee Holbrook, Julia Minocha, Anne Laumann. (2012) Body Piercing. American Journal of Clinical Dermatology 13:1, 1-17
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2. 2

   Benoit Ayestaray, Emmanuel Dudrap, Amir Chaibi. (2011) Galactorrhea After Aesthetic Breast Augmentation With Silicone Implants: Report of Two Cases and Management of Postoperative Galactorrhea. Aesthetic Plastic Surgery 35:3, 408-413
   CrossRef

3. 3

   Mary P. Gillam, Mark E. Molitch. 2011. Prolactin. , 119-166.
   CrossRef

4. 4

   N. Kluger, B. Guillot. (2010) Complications des piercings. Annales de Dermatologie et de Vénéréologie 137:2, 153-158
   CrossRef

5. 5

   Ákos Jakobovits, Antal Jakobovits. (2008) Az emlő antropológiája (Az amastiától a gigantomastiáig). Orvosi Hetilap 149:12, 561-568
   CrossRef

6. 6

   Tammie Ferringer, Howard Pride, William Tyler. (2008) Body Piercing Complicated by Atypical Mycobacterial Infections. Pediatric Dermatology 25:2, 219-222
   CrossRef

7. 7

   E. Kasten. (2007) Genitale Body-Modifications bei Frauen. Der Gynäkologe 40:6, 489-500
   CrossRef

8. 8

   MyrnaL. Armstrong, Carol Caliendo, AldenE. Roberts. (2006) Pregnancy, Lactation and Nipple Piercings. AWHONN Lifelines 10:3, 212-217
   CrossRef

9. 9

   U. I. Esen, S. Orife. (2006) Penile jewellery: a cause of post-coital bleeding. Journal of Obstetrics & Gynaecology 26:5, 483-484
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10. 10

    Carol Caliendo, Myrna L. Armstrong, Alden E. Roberts. (2005) Self-reported characteristics of women and men with intimate body piercings. Journal of Advanced Nursing 49:5, 474-484
    CrossRef

11. 11

    Yener Demirtas, Yakup Sariguney, Onur Cukurluoglu, Suhan Ayhan, Cemalettin Celebi. (2004) Nipple Piercing: It Is Wiser to Avoid in Patients with Hyperprolactinemia. Dermatologic Surgery 30:8, 1184-1184
    CrossRef