Galactorrhea

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
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