Galactorrhoea Flashcards
Definition of galactorrhoea
Copious, bilateral, multi-ductal, milky discharge from breast not associated with pregnancy or lactation.
Also means 6-12 months after pregnancy with cessation of breastfeeding
It almost exclusivley occur in females.
Lactation physiology
Regulated by prolactin secreted by the anterior pituitary.
It is controlled by dopamine which acts to inhibit it.
TRH and Oestrogen act to stimulate the release of prolactin.
Causes
Idiopathic (40%)
Pituitary adenoma
Drug induced
Neurological (VZV or spinal cord injury)
Hypothyroidism (elevated TRH)
Cushing’s, Acromegaly and Addison’s can also cause it
Renal failure or liver failure
Damage to the pituitary stsalk
Drugs that can cause galactorrhoea
SSRIs
Anti-psychotics
H2-antagonists
What is normoprolactinaemic galactorrhoea?
Typically idiopathic less common diagnosis
This is when all other causes have been excluded and blood markers are normal as well as menstruation.
What to ask about clinical features
Determine whether it is true galactorrhoea - A Sudan IV stain for fat droplets in discharge can be used - but is rarely done so.
Check for any breast lumps, mastalgia and ask about last menstrual period.
Ask about features of endocrine disease and neurologcial symptoms like headaches and visual disturbances.
Ask about DH, any form of contraception, OTC medication or recreational drug use.
Examination findings
Often unremarkable
Check for visual changes that can be suggestive of compression from pituitary mass on the optic chiasm
Check for features of hypothyroidism
Investigations
Exclude pregnancy
Serum prolactin levels
TFT
LFT
Renal function tests
IGF-1 and ACTH may be warranted
MRI head with contrast if prolactinoma
Management
Pituitary tumour -> Cabergoline or bromocriptine or trans-sphenoidal surgery
Idiopathic normoprolactinaemic galactorrhoea often resolve spontaneously
Troublesome that is refractory might warrant bilateral total duct excision
