Galactorrhoea

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Galactorrhoea is the inappropriate or spontaneous production of milk from the breast, unrelated to breastfeeding. It is often due to elevated prolactin levels and may indicate an underlying endocrine disorder.

Aetiology

  • Physiological: pregnancy, postpartum period, nipple stimulation.
  • Hyperprolactinaemia: due to pituitary adenomas (prolactinomas), hypothyroidism, chronic kidney disease.
  • Medication-induced: dopamine antagonists (e.g., antipsychotics, metoclopramide), oestrogen therapy, opioids.
  • Idiopathic: no identifiable cause.

Pathophysiology

  • Prolactin, secreted by the anterior pituitary, is normally inhibited by dopamine.
  • Increased prolactin levels result in lactogenesis and suppression of gonadotropin-releasing hormone, leading to menstrual disturbances.

Risk Factors

  • Use of dopamine antagonist medications.
  • Pituitary tumours (prolactinomas).
  • Chronic stress.
  • Hypothyroidism.
  • Chronic renal disease.

Signs and Symptoms

  • Breast: spontaneous or persistent milky nipple discharge, often bilateral.
  • Endocrine: menstrual irregularities, infertility, decreased libido.
  • Neurological: headaches, visual disturbances (if due to pituitary tumour).
  • Systemic: fatigue, weight gain (if associated with hypothyroidism).

Investigations

  • Serum prolactin levels: elevated in hyperprolactinaemia.
  • Thyroid function tests: to exclude hypothyroidism.
  • Pregnancy test: to rule out pregnancy-related galactorrhoea.
  • Pituitary MRI: indicated if prolactin levels are significantly elevated (>200 µg/L) or if there are neurological symptoms.

Management

1. Address Underlying Cause:

  • Medication-induced: consider stopping or switching causative drugs.
  • Hypothyroidism: treat with levothyroxine.
  • Prolactinoma: dopamine agonists (e.g., cabergoline, bromocriptine) to reduce prolactin levels.

2. Surgical Management:

  • Transsphenoidal surgery: for large pituitary adenomas causing mass effect.

3. Referral:

  • Endocrinology: if prolactin levels are persistently elevated or a pituitary tumour is suspected.
  • Neurosurgery: for large or symptomatic pituitary adenomas.
  • Gynaecology: if associated with menstrual irregularities or infertility.
EndocrinologymypanotesGalactorrhoea