galactorrhea Flashcards
what is galactorrhoea?
Galactorrhoea is defined as copious, bilateral, multi-ductal, milky discharge, not associated with pregnancy or lactation.
what is the physiology of lactation?
predominately controlled by the hormone prolactin, which is released from the anterior pituitary
Prolactin secretion is controlled by dopamine, released by the hypothalamus, acting to inhibit prolactin secretion. Actions of TRH and oestrogen conversely act to stimulate the release of prolactin from the pituitary.
what is the most common cause of galactorrhoea?
hyperprolactinaemia
can be
- idiopathic
- pituitary adenoma
- drug induced e.g SSRIs,H2 antagonists and antipsychotics stimulate prolactin release
- neurological e.g spinal cord injuries or infection
- hypothyroidism due to raised thyroid releasing hormone
what are the clinical features of galactorrhea?
- Clarify any additional features e.g breast lumps, mastalgia, and their last period, to assess for underlying causes or an alternative diagnosis
- Ask about features of endocrine disease and for neurological symptoms (headaches, visual disturbances)
- Breast examination is often unremarkable. Check for any visual changes (suggestive of compressive pituitary masses) or features of hypothyroidism.
what investigations can be done for galactorrhoea?
- exclude pregnancy
- serum prolactin levels
- thyroid test, liver function and renal function
- If the history & clinical examination suggests such, further endocrine tests (IGF-1, ACTH etc.)
- if pituitary tumour is suspected, MRI head with contrast
- breast imaging if any lymph nodes are palpable
how is galactorrhoea managed?
identify and treat underlying cause
If confirmed pituitary tumour, start on dopamine agonist therapy e.g Cabergoline and Bromocriptine and referred to neurosurgery for assessment for potential trans-sphenoidal surgery.
Those with troublesome galactorrhoea who are intolerant of medication, bilateral total duct excision may be required.
if idiopathic, it resolves spontaneously usually.
