Galactorrhoea Flashcards
What is galactorrhoea?
Defined as copious, bilateral, multi-ductal, milky discharge not associated with pregnancy or lactation.
Which hormone is responsible for regulating lactation?
Prolactin which is controlled by dopamine by inhibiting its release
Which hormones can stimulate the release of prolactin?
TRH
Oestrogen
What is the most common cause of galactorrhoea?
Hyperprolactinaemia
What are the cause of hyperprolactinaemic galactorrhoea?
Idiopathic - 40%
Pituitary adenoma
Drug-induced - SSRIs, antipsychotics or H2 antagonists
Neurological - neurogenic pathways activated to inhibit dopamine release - varicella zoster infection, spinal cord injury
Hypothyroidism
Renal failure or liver failure
Damage to pituitary stalk - from surgical resection, MS, sarcoidosis or TB
What is a less common cause of galactorrhoea?
Normoprolactinaemic galactorrhoea - must exclude other causes first
What are important things to ask and examine in galactorrhoea?
Determine that it is true galactorrhoea not alternative nipple discharge
Additional features such as breast lumps, mastalgia and their last menstrual period
Endocrine disease features or neurological feature (headaches + visual disturbance)
Drug history
Breast examination should be unremarkable
Visual changes - pituitary masses
Features of hypothyroidism
What investigations should be requested in galactorrhoea?
Pregnancy test - in all women of reproductive age
Serum prolactin levels
TFT, LFTS, renal function tests
Further endocrine test is history indicates it.
When should a prolactinoma be suspected?
Prolactin levels >1000 mU/L in absence of any drug cause
What investigation should be ordered in suspected pituitary tumor?
MRI head with contrast
What is the management of galactorrhoea?
Treat underlying cause
Normoprolactinomic galactorrhoea - resolves spontaneously but low-dose dopamine agonist could be trialled
If intolerant to medication the bilateral total duct excision may be required
What treatment is available for pituitary adenomas?
Dopamine agonist therapy (cabergoline and bromocriptine)
Refer to neurosurgery for assessment for potential trans-sphenoidal surgery
