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Galactorrhea
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Galactorrhea
See Also
Nipple Discharge
Hyperprolactinemia
Hyperprolactinemia Causes
Definition
Non-
Lactation
al milk production and discharge from the
Breast
Men and children
Women (non-lactating, >12 months postpartum)
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 Contraceptive
s are most common cause
See
Medication Causes of Hyperprolactinemia
Gynecologic history
Amenorrhea
or oligomenorrha
Decreased libido
Recent pregnancies,
Miscarriage
s 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
Examination
Assess growth: Height and weight
Decreased growth
Hypopituitarism
Hypothyroidism
Chronic Renal Failure
Increased growth (
Acromegaly
)
Pituitary tumor
Assess
Vital Sign
s
Bradycardia
:
Hypothyroidism
Tachycardia
:
Thyrotoxicosis
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
Imaging
Brain (if indicated)
See
Hyperprolactinemia
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
Interpretation
Non-Galactorrhea
Evaluate for
Breast
pathology
See
Nipple Discharge
Galactorrhea
Follow step 2 below
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)
Serum
Estrogen
Serum Testosterone
Follicle Stimulating Hormone
Luteinizing hormone
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 Negative
Prolactin
seen with very large
Prolactinoma
s (hook effect)
Consider asking lab to re-run
Serum Prolactin
at 1:100 dilution
Consider MRI Brain
See
Hyperprolactinemia
Management
See
Hyperprolactinemia
References
Falkenberry (2002) Obstet Gynecol Clin North Am 29:21-9 [PubMed]
Huang (2012) Am Fam Physician 85(11): 1073-80 [PubMed]
Leung (2004) Am Fam Physician 70:543-54 [PubMed]
Pena (2001) Am Fam Physician 63:1763-70 [PubMed]
Yazigi (1997) Fertil Steril 67:215-25 [PubMed]
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