Galactorrhea

Aka: Galactorrhea

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II. Definition

  1. Non-Lactational milk production and discharge from the Breast
    1. Men and children
    2. Women (non-lactating, >12 months postpartum)

III. Causes

  1. See Causes of Hyperprolactinemia
  2. See Medication Causes of Hyperprolactinemia

IV. Differential Diagnosis

  1. See Nipple Discharge

V. History

  1. Nipple Discharge
    1. See Nipple Discharge
    2. Pathologic discharge
      1. Unilateral discharge or discharge from a single duct
      2. Bloody, serosanguineous or purulent discharge
    3. Normal discharge
      1. Galactorrhea is typically milky, bilateral and multi-ductal
      2. Coloration can vary (yellow to brown, or even green)
      3. Precipitated by Breast stimulation
  2. Medications
    1. Oral Contraceptives are most common cause
    2. See Medication Causes of Hyperprolactinemia
  3. Gynecologic history
    1. Amenorrhea or oligomenorrha
    2. Decreased libido
    3. Recent pregnancies, Miscarriages or abortions
  4. Past medical history
    1. Chest surgery or injury
    2. Hypothyroidism
    3. Chronic Kidney Disease
  5. Family History
    1. Multiple endocrine neoplasia (esp. Type I)
    2. Thyroid disease
  6. Social history
    1. Recent emotional stress
  7. Associated symptoms for common pathologic causes
    1. Prolactinoma
      1. Age 20 to 35 years
      2. Headache or vision change
      3. Seizure disorder
      4. Polyuria or Polydypsia
    2. Hyperprolactinemia
      1. Amenorrhea
      2. Decreased libido
      3. Infertility
    3. Hypothyroidism
      1. Fatigue
      2. Cold Intolerance
      3. Constipation

VI. Examination

  1. Assess growth: Height and weight
    1. Decreased growth
      1. Hypopituitarism
      2. Hypothyroidism
      3. Chronic Renal Failure
    2. Increased growth (Acromegaly)
      1. Pituitary tumor
  2. Assess Vital Signs
    1. Bradycardia: Hypothyroidism
    2. Tachycardia: Thyrotoxicosis
  3. Chest exam
    1. Observe for local injury or infection
    2. Breast Exam (see Nipple Discharge)
  4. Associated signs for common pathologic causes
    1. Pituitary mass
      1. Visual field deficit
      2. Papilledema
      3. Cranial Nerve dysfunction
    2. Hyperprolactinemia
      1. Hyperandrogenism (e.g. Hirsutism, Acne Vulgaris)
    3. Hypothyroidism
      1. ThyroidGoiter
      2. Myxedema
      3. Coarse hair or Dry Skin

VII. Imaging: Brain (if indicated)

  1. See Hyperprolactinemia

VIII. Evaluation: Step 1

  1. Evaluate for Galactorrhea
    1. Consider examining discharge under microscope
      1. Typically not performed, but consider if appearance is not definitive for milky discharge
      2. Sudan IV Stain will demonstrate fat globules in discharge consistent with Galactorrhea
    2. Amenorrhea present? (see history above)
      1. Galactorrhea with Amenorrhea is pathognomonic for Hyperprolactinemia
      2. Galactorrhea without Amenorrhea is associated with normal Serum Prolactin
  2. Interpretation
    1. Non-Galactorrhea
      1. Evaluate for Breast pathology
      2. See Nipple Discharge
    2. Galactorrhea
      1. Follow step 2 below

IX. Evaluation: Step 2

  1. Tests
    1. Quantitative Serum Beta hCG (Urine Pregnancy Test)
    2. Serum Prolactin Level
      1. Delay measurement until at least 30 minutes or more after vigorous Exercise or Breast Exam or stimulation
    3. Thyroid Stimulating Hormone (TSH) Level
    4. Serum Creatinine
    5. Sex hormones (if Hypogonadism suspected)
      1. Serum Estrogen
      2. Serum Testosterone
      3. Follicle Stimulating Hormone
      4. Luteinizing hormone
  2. Interpretation
    1. Hypothyroidism
      1. Replace Thyroid hormone
    2. Prolactin Level > 20 ng/ml
      1. See Hyperprolactinemia
      2. Consider MRI Brain (see imaging above)
    3. Normal labs
      1. Regular Menses
        1. Observe
        2. Periodically recheck Serum Prolactin levels
      2. Amenorrhea or oligomenorrhea
        1. Consider false negative Prolactin seen with very large Prolactinomas (hook effect)
        2. Consider asking lab to re-run Serum Prolactin at 1:100 dilution
        3. Consider MRI Brain
        4. See Hyperprolactinemia

X. Management

  1. See Hyperprolactinemia

XI. References

  1. Falkenberry (2002) Obstet Gynecol Clin North Am 29:21-9 [PubMed]
  2. Huang (2012) Am Fam Physician 85(11): 1073-80 [PubMed]
  3. Leung (2004) Am Fam Physician 70:543-54 [PubMed]
  4. Pena (2001) Am Fam Physician 63:1763-70 [PubMed]
  5. Yazigi (1997) Fertil Steril 67:215-25 [PubMed]

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Ontology: Galactorrhea not associated with childbirth (C0235660)

Concepts Disease or Syndrome (T047)
MSH C537072
ICD9 611.6
ICD10 N64.3
SnomedCT 78622004, 198115002
French GALACTORRHEE, Allaitement non puerpéral, Galactorrhée non liée à la naissance, Galactorrhée chez la femme, Lactation non puerpérale, LACTATION NON PUERPERALE, Galactorrhée
English Galactorrhea not associated with childbirth, GALACTORRHEA, GALACTORRHOEA, LACTATION NONPUERPERAL, Inappropriate milk production, nonpuerperal galactorrhea, nonpuerperal galactorrhea (diagnosis), Galactorrhea - non-obstetric, Galactorrhoea - non-obstetric, Galactorrhea female, Lactation non-puerperal, Lactation nonpuerperal, Galactorrhea-nonobstet, Nonpuerperal galactorrhea, Galactorrhoea female, Galactorrhea, Galactorrhoea, Inappropriate lactation, Inappropriate production of milk, Milk from non-pregnant breast, Galactorrhoea not associated with childbirth, Galactorrhea due to non-obstetric cause, Galactorrhoea due to non-obstetric cause, Galactorrhea due to non-obstetric cause (disorder), Galactorrhea not associated with childbirth (disorder), galactorrhea; not associated with childbirth, lactation; nonpuerperal, nonpuerperal; lactation, Galactorrhea, NOS
Portuguese GALACTORREIA, Lactação não puerperal, Galactorreia não associada a parto, Galactorreia na mulher, LACTACAO NAO PUERPERAL, Galactorreia
Spanish GALACTORREA, Lactación no puerperal, Lactancia no puerperal, Galactorrea no asociada al parto, Galactorrea femenina, SECRECION LACTEA NO PUERPERAL, galactorrea de causa no obstétrica (trastorno), galactorrea de causa no obstétrica, galactorrea no asociada con el nacimiento (trastorno), galactorrea no asociada con el nacimiento, galactorrea, Galactorrea
German GALAKTORRHOE, Galaktorrhoe, nicht assoziiert mit Geburt, Laktation, nicht puerperal, Laktation, puerperal, Galaktorrhoe, weiblich, Galaktorrhoe, nicht im Zusammenhang mit der Geburt, LAKTATION OHNE SCHWANGERSCHAFT, Galaktorrhoe
Italian Galattorrea, Galattorrea femminile, Lattazione non puerperale, Galattorrea non associata con il parto
Dutch galactorrhoea niet veroorzaakt door geboorte kind, galactorrhoea vrouw, niet-puerperale lactatie, galactorroe; niet samenhangend met bevalling, lactatie; niet-puerperaal, niet-puerperaal; lactatie, Galactorroe zonder verband met bevalling, galactorroe
Japanese 乳汁漏出症, 非産褥性乳汁分泌, ﾆｭｳｼﾞｭｳﾛｳｼｭﾂｼｮｳ, ﾋｻﾝｼﾞｮｸｾｲﾆｭｳｼﾞｭｳﾌﾞﾝﾋﾟ, ﾋｻﾝｼﾞｮｸｾｲﾆｭｳｼﾞｭｳﾌﾞﾝﾋﾟﾂ, ﾌﾞﾝﾍﾞﾝﾆﾄﾓﾅﾜﾅｲﾆｭｳｼﾞｭｳﾛｳｼｭﾂｼｮｳ, 分娩に伴わない乳汁漏出症, ｼﾞｮｾｲﾆｭｳｼﾞｭｳﾛｳｼｭﾂｼｮｳ, 女性乳汁漏出症
Czech Galaktorea u ženy, Galaktorea, Galaktorea nesouvisející s porodem, Laktace nepuerperální
Korean 출산과 관련되지 않은 젖흐름증
Hungarian Szüléshez nem kapcsolódó galactorrhoea, Nem gyermekágyi tejelválasztás, Galactorrhoea, Szüléstől független galactorrhoea, Női galactorrhoea
Derived from the NIH UMLS (Unified Medical Language System)

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