Galactorrhea
Basics
Basics
Basics
Description
Description
Description
- Milky nipple discharge not associated with lactation, defined as >1 year after pregnancy or cessation of breastfeeding
- Does not include serous, purulent, or bloody nipple discharge
- System(s) affected: endocrine/metabolic, nervous, reproductive
Pediatric Considerations
Can occur in infants secondary to maternal estrogen exposure
Pregnancy Considerations
- Pregnancy stimulates lactotroph cells, so pituitary prolactin-secreting macroadenomas may increase by 21% (1)[A].
- Milk production often begins during the 2nd trimester; milk leakage that occurs during pregnancy is not pathophysiologic galactorrhea.
Epidemiology
Epidemiology
Epidemiology
Predominant age: 15 to 50 years (reproductive age), most commonly ages 20–35; third most common breast complaint in women
Incidence
Marked variability reported
Prevalence
Approximately 20–25% of women experience galactorrhea in their lifetime.
Etiology and Pathophysiology
Etiology and Pathophysiology
Etiology and Pathophysiology
- Oxytocin stimulates prolactin secretion, which induces lactation. Prolactin is secreted by the anterior pituitary and inhibited by dopamine produced in the hypothalamus.
- Galactorrhea results either from prolactin overproduction or from loss of inhibitory regulation by dopamine.
- Physiologic galactorrhea is due to pregnancy or from nipple stimulation, piercing.
- Pathophysiologic galactorrhea
- Hyperprolactinemia (craniopharyngiomas, other tumors; irradiation; traumatic brain injury; pituitary stalk compression; postbreast augmentation surgery [1%]; prolactinoma [sellar tumor, somatotroph adenoma, pituitary macroadenoma]; vascular malformations [aneurysms])
- Hyperprolactinemia in systemic diseases (adrenal insufficiency, chronic kidney disease, cirrhosis, thyroid disease, lung cancer, renal cell cancer, sarcoidosis/histiocytosis)
- Nonhyperprolactinemia
- Chest wall trauma; spinal cord injury
- Chiari-Frommel, del Castillo, and Forbes-Albright syndromes
- Herpes zoster
- Medications/substances:
- Cardiovascular (α-methyldopa, reserpine, verapamil, spironolactone)
- GI (domperidone, H2 blockers, metoclopramide, proton pump inhibitors) (2)[C]
- Herbal (anise [licorice], barley, blessed thistle, fenugreek seed, fennel, goat’s rue)
- Illicit (cocaine, marijuana)
- Anti-infectives (isoniazid, protease inhibitors)
- Opioids
- Psych/neuro (neuroleptics, antipsychotics, stimulants, SSRIs, SNRIs [prolactin not always elevated], tricyclic antidepressants, MAOIs) (3)[C]
- Reproductive (estrogens, copper IUD)
- DMARDs (azathioprine)
- Normal prolactin levels (if patient has galactorrhea plus amenorrhea, likely can have microprolactinoma)
Risk Factors
Risk Factors
Risk Factors
See “Etiology and Pathophysiology.”
General Prevention
General Prevention
General Prevention
- Avoid frequent nipple stimulation.
- Avoid medications that can suppress dopamine.
Commonly Associated Conditions
Commonly Associated Conditions
Commonly Associated Conditions
See “Etiology and Pathophysiology.”
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