Galactorrhea

Chapter 156 Galactorrhea



INTRODUCTION



Description: Spontaneous, bilateral nipple discharge (milky fluid only) is called galactorrhea.

Prevalence: Uncommon, but reports vary from 1% to 30%, depending on the population studied.

Predominant Age: Reproductive.

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Pituitary adenoma, disruptions in thyroid or prolactin hormone levels, pharmacologic (most often those drugs that affect dopamine or serotonin), autoimmune disease (sarcoid, lupus), Cushing’s disease, herpes zoster, chest wall/breast stimulation or irritation, physiologic changes during pregnancy or after childbirth and/or breastfeeding, specific foods (licorice).

Risk Factors: None known.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Bilateral, spontaneous, milky discharge from both breasts

• Often symptoms of underlying pathologic condition (e.g., hypothyroidism, Cushing’s disease, or pituitary enlargement)

• Amenorrhea common


DIAGNOSTIC APPROACH



Differential Diagnosis



• Pregnancy

• Breast cancer

• Chronic nipple stimulation

• Hypothyroidism

• Sarcoidosis

• Lupus

• Cirrhosis or hepatic disease


Associated Conditions: One third of patients with an elevated prolactin level experience amenorrhea or infertility. Prolonged amenorrhea is associated with an increased risk of osteoporosis, vaginal and genital atrophic changes, dyspareunia, and libidinal dysfunction.


Workup and Evaluation



Laboratory:

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Galactorrhea

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