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Galactorrhea
Aka: Galactorrhea- See Also
- Definition
- Causes
- See Causes of Hyperprolactinemia
- See Medication Causes of Hyperprolactinemia
- Differential Diagnosis
- See Nipple Discharge
- History
- Nipple Discharge
- See Nipple Discharge
- Pathologic discharge
- Unilateral discharge or discharge from a single duct
- Bloody, serosanguineous or purulent discharge
- Normal discharge
- Galactorrhea is typically milky, bilateral and multi-ductal
- Coloration can vary (yellow to brown, or even green)
- Precipitated by Breast stimulation
- Medications
- Oral Contraceptives are most common cause
- See Medication Causes of Hyperprolactinemia
- Gynecologic history
- Amenorrhea or oligomenorrha
- Decreased libido
- Recent pregnancies, Miscarriages or abortions
- Past medical history
- Chest surgery or injury
- Hypothyroidism
- Chronic Kidney Disease
- Family History
- Multiple endocrine neoplasia (esp. Type I)
- Thyroid disease
- Social history
- Recent emotional stress
- Associated symptoms for common pathologic causes
- Prolactinoma
- Age 20 to 35 years
- Headache or Vision change
- Seizure Disorder
- Polyuria or Polydypsia
- Hyperprolactinemia
- Amenorrhea
- Decreased libido
- Infertility
- Hypothyroidism
- Fatigue
- Cold Intolerance
- Constipation
- Prolactinoma
- Nipple Discharge
- Examination
- Assess growth: Height and weight
- Decreased growth
- Increased growth (Acromegaly)
- Pituitary tumor
- Assess Vital Signs
- Chest exam
- Observe for local injury or infection
- Breast Exam (see Nipple Discharge)
- Associated signs for common pathologic causes
- Pituitary mass
- Visual Field deficit
- Papilledema
- Cranial Nerve dysfunction
- Hyperprolactinemia
- Hyperandrogenism (e.g. Hirsutism, Acne Vulgaris)
- Hypothyroidism
- Thyroid Goiter
- Myxedema
- Coarse hair or Dry Skin
- Pituitary mass
- Assess growth: Height and weight
- Imaging: Brain (if indicated)
- Evaluation: Step 1
- Evaluate for Galactorrhea
- Consider examining discharge under microscope
- Typically not performed, but consider if appearance is not definitive for milky discharge
- Sudan IV Stain will demonstrate fat globules in discharge consistent with Galactorrhea
- Amenorrhea present? (see history above)
- Galactorrhea with Amenorrhea is pathognomonic for Hyperprolactinemia
- Galactorrhea without Amenorrhea is associated with normal Serum Prolactin
- Consider examining discharge under microscope
- Interpretation
- Non-Galactorrhea
- Evaluate for Breast pathology
- See Nipple Discharge
- Galactorrhea
- Follow step 2 below
- Non-Galactorrhea
- Evaluate for Galactorrhea
- Evaluation: Step 2
- Tests
- Quantitative Serum Beta hCG (Urine Pregnancy Test)
- Serum Prolactin Level
- Delay measurement until at least 30 minutes or more after vigorous Exercise or Breast Exam or stimulation
- Thyroid Stimulating Hormone (TSH) Level
- Serum Creatinine
- Sex Hormones (if Hypogonadism suspected)
- Interpretation
- Hypothyroidism
- Replace Thyroid Hormone
- Prolactin Level > 20 ng/ml
- See Hyperprolactinemia
- Consider MRI Brain (see imaging above)
- Normal labs
- Regular Menses
- Observe
- Periodically recheck Serum Prolactin levels
- Amenorrhea or Oligomenorrhea
- Consider False NegativeProlactin seen with very large Prolactinomas (hook effect)
- Consider asking lab to re-run Serum Prolactin at 1:100 dilution
- Consider MRI Brain
- See Hyperprolactinemia
- Regular Menses
- Hypothyroidism
- Tests
- Management
- References