@AnKing-Maintainers AMBOSS actually does cover this. (But it requires you to be in clinician mode).
These things are called “galactagogues” they are considered second line to “increased breast emptying (first line)” a reasonable alternative might be improving the text to not give the impression that the entire pituitary is destroyed (maybe “damage” or “impairment”).
While I agree this is probably not step 1/2 relevant it is accurate. We need to be careful about removing things so quickly and remember that this deck was put together meticulously and there is most likely a reason it was added and we should be verifying why that was before removing something to ensure we are truly improving the deck and not deteriorating prior labors.
You’re right, I was too hasty, my bad, wont happen again. I approached this card from the perspective that anterior pituitary destruction (e.g. Sheehan syndrome) was the main subject of the card, not prolactin deficiency, but I can see your perspective @Jwill. Galactagogues work by stimulating prolactin secretion from pituitary lactotrophs, but in Sheehan syndrome, these cells are destroyed. So the extra text is inaccurate from the destruction perspective, thus why I was so hasty to remove the inaccuracy. How about we replace it with:
May be treated with dopamine antagonists or estrogen in patients with functioning lactotrophs
I can resubmit if you think its worth it.
I did go through the lactation failure amboss article, but I think that is not specifically related to Sheehan syndrome, rather just general lactational failure. I went through pubmed and statpearls literature and couldn’t find galactogogues mentioned anywhere in Sheehan syndrome treatment.
I went through uptodate as well, and that mentions, verbatim, that " The only presentation of prolactin deficiency is the inability to lactate after delivery, for which there is currently no available treatment. "
I think it is better to not mention anything, since the literature isn’t that clear.
I did go through the lactation failure amboss article, but I think that is not specifically related to Sheehan syndrome, rather just general lactational failure. I went through pubmed and statpearls literature and couldn’t find galactogogues mentioned anywhere in Sheehan syndrome treatment.
I went through uptodate as well, and that mentions, verbatim, that " The only presentation of prolactin deficiency is the inability to lactate after delivery, for which there is currently no available treatment. " [see attachment]
I think it is better to not mention anything, since the literature isn’t that clear.
Treatment of hypopituitarism.pdf (90.5 KB)
Thanks for checking!
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