Galactorrhoea

Question 1

What is it

Answer 1

Milk production not associated with pregnancy or breastfeeding

Question 2

What hormone stimulate breast milk production? Where is it produced?

Answer 2

Prolactin in anterior pituitary gland

Question 3

what hormones inhibit secretion breast milk production and how

Answer 3

Oestrogen and progesterone as they inhibit secretion of prolactin

Question 4

what hormone stimulates milk excretion? When is it produced?

Answer 4

Oxytocin shortly after birth

Question 5

What are causes of hyperprolactinaemia?

Answer 5

Idiopathic
Prolactinomas
Endocrine disorders - hypothyroidism and PCOS
Meds - dopamine antagonists

Question 6

What associated features may there be with hyperprolactinaemia and why ?

Answer 6

Prolactin suppresses GnRH so reduced LH and FSH
Therefore:
Menstrual irregularities
Reduced libido
Erectile dysfunction
Gynaecomastia

Question 7

What condition are prolactinomas associated with?>

Answer 7

Multiple endocrine neoplasia type 1

Question 8

What other conditions lead to non-milk discharge?

Answer 8

mammary duct ectasia
duct papilloma
pus from a breast abscess

Question 9

What investigations would you consider

Answer 9

Pregnancy test
Serum prolactin
UEs, LFTs, TFTs,
MRI headWh

Question 10

What is medical management ?

Answer 10

Dopamine agonists as they inhibit prolactin e.g. bromocriptine, cabergoline

Question 11

What are surgical options ?

Answer 11

Trans-sphenoidal surgical removal of the pituitary tumour