Idiopathic Breast Hypertrophy with Hyperprolactinemia in a Postmenopausal Female: A Case Report of Successful Management with Tamoxifen and Cabergoline

Abstract

Confidential – For Author Use OnlyTitle:Idiopathic Breast Hypertrophy with Hyperprolactinemia in a Postmenopausal Female: A Case Report of Successful Management with Tamoxifen and CabergolineAuthors:Christian Mbije, MDDepartment of Endocrinology, Mbeya Zonal Referral Hospital, Mbeya- TanzaniaFredrick Chinyama,Department of Internal Medicine, University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya -Tanzania.Email: fredrickchinyama52@gmail.comCorresponding Author:Christian Mbije, MD,,EndocrinologistEmail: cmbije455@gmail.comPhone: +255769503643AbstractBreast hypertrophy in postmenopausal women is typically evaluated for malignant, hormonal, or pharmacologic etiologies. We present a rare case of a 56-year-old postmenopausal female with progressive, symptomatic bilateral breast hypertrophy and associated idiopathic hyperprolactinemia, in the absence of a pituitary adenoma on imaging or any causative medications. Initial evaluation revealed elevated prolactin (128 ng/mL) with otherwise normal pituitary, thyroid, and adrenal hormones. Breast imaging confirmed hypertrophy without malignancy. The patient was treated with cabergoline (0.5 mg twice weekly) to normalize prolactin and tamoxifen (20 mg daily) to antagonize estrogen receptor activity in breast tissue. At three-month follow-up, prolactin normalized (18 ng/mL) and a significant reduction in breast size and symptoms was observed. This case demonstrates that hyperprolactinemia, even without galactorrhea or a visible pituitary lesion, can drive significant breast enlargement and responds well to targeted medical therapy. Combination treatment with a dopamine agonist and a selective estrogen receptor modulator may be an effective strategy for similar idiopathic cases.Key clinical message:Breast hypertrophy in postmenopausal women is typically evaluated for malignant, hormonal, or pharmacologic etiologies. We present a rare case of a 56-year-old postmenopausal female with progressive, symptomatic bilateral breast hypertrophy and associated idiopathic hyperprolactinemia, in the absence of a pituitary adenoma on imaging or any causative medications. This case demonstrates that hyperprolactinemia, even without galactorrhea or a visible pituitary lesion, can drive significant breast enlargement and responds well to targeted medical therapy. Combination treatment with a dopamine agonist and a selective estrogen receptor modulator may be an effective strategy for similar idiopathic casesKeywords : Breast hypertrophy, macromastia, hyperprolactinemia, cabergoline, tamoxifen, postmenopausal, idiopathic.