TOC  |  ENDO

*GALACTORRHEA / HYPERPROLACTINEMIA

Milky nipple discharge. Galactorrhea technically does not include serous, purulent, or bloody nipple discharge.

SX:

CAUSES:

  1. Physiologic (pregnancy and up to 6 months after delivery or after stopping breast-feeding)
  2. Prolactin producing pituitary adenoma
  3. Medications (e.g., opioids, tricyclics, metoclopramide, verapamil, phenothiazines, alpha-methyldopa, isoniazid, estrogens, reserpine, butyrophenones)
  4. Oral contraceptive pill withdrawal
  5. Hypothyroidism
  6. Chest wall conditions (e.g., herpes zoster, post-thoracotomy, fibrocystic breast changes)
  7. Postoperative state (any major surgery, but especially oophorectomy)
  8. Chiari-Frommel (idiopathic galactorrhea more than 6 months postpartum)
  9. Idiopathic
  10. Miscellaneous causes (e.g., sarcoid, renal failure, Cushing's disease, cirrhosis, head trauma, lupus, multiple sclerosis or other pituitary or hypothalamic disease)

DIFF-DX:

LAB:

SPECIAL TESTS: Formal visual field testing if pituitary adenoma suspected

IMAGING:

RX:

SURGICAL MEASURES

Large adenomas may be treated with x-ray therapy (variable success, 50% risk of panhyperpituitarism at 5 years) or transsphenoidal adenoma removal (variable success, recurrence common)

Ref:
Dambro: Griffith's 5-Minute Clinical Consult, 1999


GALACTORRHEA its physiological classification

1. Failure of normal hypothalamic inhibition of prolactin release

2. Enhanced prolactin releasing factor: Hypothyroidism

3. Enhanced prolactin release independent of normal mechanisms

a. Pituitary tumors

  1. Prolactin secreting tumors (Forbes Albright's syndrome)
  2. Mixed growth hormone & prolactin

b. Ectopic production of human placental lactogen & prolactin

  1. Hydatidiform moles & chorioepitheliomas
  2. Others (bronchogenic Ca & hypernephroma)

4. Idiopathic (following or not following pregnancy or contraceptions)

HYPERPROLACTINEMIA CAUSES:

1. Physiologic: Pregnancy, Stress (e.g. surgery), suckling, sexual intercourse, sleep, exercise, meals

2. Pharmacologic: various drugs (e.g. chlorpromazine, haloperidol), oral contraceptives, estrogens, thyrotropin releasing hormone, parathyroid hormone, insulin induced hypoglycemia, arginine

3. Pathologic:

     

04122001