Galactorrhea

1. See Also
   1. Nipple Discharge
   2. Hyperprolactinemia
2. Definition
   1. Milk discharge from Breast
      1. Men and children
      2. Women (non-lactating, >6 months postpartum)
3. Causes
   1. See Causes of Hyperprolactinemia
   2. See Medication Causes of Hyperprolactinemia
4. History
   1. Nipple Discharge
      1. See Nipple Discharge
      2. Pathologic discharge
         1. Unilateral discharge
         2. Bloody, serosanguineous or purulent discharge
      3. Normal discharge
         1. Milky discharge often bilateral
         2. Precipitated by Breast stimulation
   2. Medications
      1. Oral Contraceptives are most common cause
      2. See Medication Causes of Hyperprolactinemia
   3. Gynecologic history
      1. Amenorrhea and other menstrual history
      2. Recent pregnancies, abortions and other ob history
   4. Past medical history
      1. Chest surgery
      2. Hypothyroidism
      3. Chronic Renal Failure
   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. Decreased libido
         2. Infertility
         3. Amenorrhea
      3. Hypothyroidism
         1. Fatigue
         2. Cold Intolerance
         3. Constipation
5. 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
6. Evaluation: Step 1
   1. Evaluate for Galactorrhea
      1. Examine discharge under microscope
      2. Fat globules in discharge suggests Galactorrhea
   2. Interpretation
      1. Non-Galactorrhea
         1. Evaluate for Breast pathology
         2. See Nipple Discharge
      2. Galactorrhea
         1. Follow step 2 below
7. Evaluation: Step 2
   1. Tests
      1. Quantitative Serum Beta hCG (Urine Pregnancy Test)
      2. Serum Prolactin Level
      3. Thyroid Stimulating Hormone (TSH) Level
      4. Renal Function tests
         1. Blood Urea Nitrogen (BUN)
         2. Serum Creatinine
   2. Interpretation
      1. Hypothyroidism
         1. Replace Thyroid hormone
      2. Prolactin Level > 20 ng/ml
         1. See Hyperprolactinemia
         2. Obtain MRI Head
      3. Normal labs
         1. Regular Menses
            1. Observe
            2. Periodically recheck serum Prolactin levels
         2. Irregular Menses
            1. See Hyperprolactinemia
            2. Obtain MRI Head
8. References
   1. Falkenberry (2002) Obstet Gynecol Clin North Am 29:21-9
   2. Leung (2004) Am Fam Physician 70:543-54
   3. Pena (2001) Am Fam Physician 63:1763-70
   4. Yazigi (1997) Fertil Steril 67:215-25