Galactorrhea
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Basics
Description
- Milky nipple discharge not associated with gestation or present >1 year after weaning. Galactorrhea 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
- Milk production often begins during the 2nd trimester; milk leakage that occurs during pregnancy is not pathophysiologic galactorrhea.
Epidemiology
Predominant age: 15 to 50 years (reproductive age), most commonly ages 20 to 35
Incidence
Prolactinomas, as a cause of galactorrhea, have a 44.4 persons per 100,000 incidence in adults (2).
Prevalence
Third most common breast complaint in women. 20–25% of women experience galactorrhea in their lifetime (3)[C].
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/histocytosis)
- 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) (4)[C]
- Herbal (anise [liquorice], barley, blessed thistle, fenugreek seed, fennel, goat’s rue)
- Illicit (cocaine, marijuana) (3)[C]
- Anti-infectives (isoniazid, protease inhibitors)
- Opioids
- Psych/neuro (neuroleptics, antipsychotics, stimulants, SSRIs, SNRIs [prolactin not always elevated], tricyclic antidepressants)
- Reproductive (estrogens, copper IUD)
- Normal prolactin levels (if patient has galactorrhea plus amenorrhea, likely can have microprolactinoma)
General Prevention
- Avoid frequent nipple stimulation.
- Avoid medications that can suppress dopamine.
Commonly Associated Conditions
See “Etiology and Pathophysiology.”
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Milky nipple discharge not associated with gestation or present >1 year after weaning. Galactorrhea 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
- Milk production often begins during the 2nd trimester; milk leakage that occurs during pregnancy is not pathophysiologic galactorrhea.
Epidemiology
Predominant age: 15 to 50 years (reproductive age), most commonly ages 20 to 35
Incidence
Prolactinomas, as a cause of galactorrhea, have a 44.4 persons per 100,000 incidence in adults (2).
Prevalence
Third most common breast complaint in women. 20–25% of women experience galactorrhea in their lifetime (3)[C].
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/histocytosis)
- 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) (4)[C]
- Herbal (anise [liquorice], barley, blessed thistle, fenugreek seed, fennel, goat’s rue)
- Illicit (cocaine, marijuana) (3)[C]
- Anti-infectives (isoniazid, protease inhibitors)
- Opioids
- Psych/neuro (neuroleptics, antipsychotics, stimulants, SSRIs, SNRIs [prolactin not always elevated], tricyclic antidepressants)
- Reproductive (estrogens, copper IUD)
- Normal prolactin levels (if patient has galactorrhea plus amenorrhea, likely can have microprolactinoma)
General Prevention
- Avoid frequent nipple stimulation.
- Avoid medications that can suppress dopamine.
Commonly Associated Conditions
See “Etiology and Pathophysiology.”
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