Lactation
- Galactorrhea = producing milk from breasts
- This is a response to prolactin hormone
- Prolactin produced in the anterior pituitary, but also from cells in other organs such as the breast and prostate
- Regulates production of breast milk
- Also regulates immune function and metabolism
- Dopamine blocks secretion of prolactin
Pregnancy and Post-Breastfeeding
- Can start during the second trimester
- Can continue 2 years after breastfeeding
- Consider a pregnancy test in a lady who presents with galactorrhea
Idiopathic Hyperprolactinaemia
- Elevated blood prolactin levels
- No pituitary or other disease found
- Usually self-limiting and benign
- Can be treated with bromocriptine (dopamine agonist)
Prolactinomas
- Tumour of the pituitary gland
- Most common in patients aged 20-40
- Symptoms include:
- Gynaecomastia
- Sexual dysfunction
- Amenorrhea
- Infertility
- Bitemporal hemianopia
- Galactorrhea
- Microprolactinomas <1cm
- Macroprolactinomas >1cm
- Associated with Multiple Endocrine Neoplasia Type 1 (MEN1)
- Treated with bromocriptine (dopamine agonist) or surgery
Drugs
- Female contraceptives
- SSRIs
- Antipsychotics, domperidone and metoclopramide (dopamine antagonists)
- Methyldopa
- Beta blockers
- Digoxin
- Spironolactone
Endocrine Disorders
- Hypothyroid
- Acromegaly
- Cushings
- Polycystic Ovarian Syndrome (PCOS)
Other Causes
- Liver Failure
- Chronic Kidney Disease
