Galactorrhoea

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

Definition

Galactorrhoea is the spontaneous flow of milk from the breast, unrelated to breastfeeding or childbirth. It can occur in both men and women and is usually a sign of an underlying endocrine disorder or a side effect of certain medications.

Aetiology

Galactorrhoea can be caused by a variety of factors, including:

• Hyperprolactinaemia: Excessive production of prolactin by the pituitary gland, often due to a prolactinoma (a benign tumour of the pituitary gland) or hypothyroidism.
• Medications: Certain medications such as antipsychotics, antidepressants, and antihypertensives can increase prolactin levels, leading to galactorrhoea.
• Chronic Renal Failure: Impaired clearance of prolactin can result in elevated prolactin levels and subsequent galactorrhoea.
• Chest Wall Stimulation: Conditions such as shingles affecting the chest, or physical stimulation from activities like frequent breast self-exams, can also trigger the release of prolactin.
• Idiopathic: In some cases, no identifiable cause is found, and the condition is termed idiopathic galactorrhoea.

Pathophysiology

Galactorrhoea typically results from elevated levels of prolactin, a hormone produced by the anterior pituitary gland that stimulates milk production. The prolactin levels can rise due to pituitary tumours, hypothyroidism, certain medications, or other underlying conditions. Elevated prolactin stimulates the mammary glands, leading to milk production even in the absence of pregnancy or postpartum status.

Risk Factors

• Female gender, particularly women of reproductive age.
• Use of medications that increase prolactin levels (e.g., antipsychotics, antidepressants).
• History of endocrine disorders, such as hypothyroidism or pituitary adenomas.
• Chronic renal failure, which can impair prolactin clearance.
• Frequent physical stimulation of the breast or chest wall.

Signs and Symptoms

• Spontaneous or persistent milky discharge from one or both breasts.
• Amenorrhoea or irregular menstrual periods in women.
• Decreased libido and erectile dysfunction in men.
• Headaches or visual disturbances, particularly if a pituitary tumour is present.
• Tenderness or fullness in the breasts.

Investigations

• Prolactin Levels: Serum prolactin measurement is essential to confirm hyperprolactinaemia.
• Thyroid Function Tests: To rule out hypothyroidism as a cause of elevated prolactin levels.
• Magnetic Resonance Imaging (MRI): Indicated if a pituitary tumour (prolactinoma) is suspected, particularly in the presence of elevated prolactin levels.
• Renal Function Tests: To assess for chronic renal failure, which can contribute to elevated prolactin levels.
• Pregnancy Test: To rule out pregnancy as a cause of lactation.

Management

• Primary Care:
  • Medication Review: Discontinue or substitute any medications that may be contributing to elevated prolactin levels, if possible.
  • Thyroid Replacement Therapy: In cases of hypothyroidism, thyroid hormone replacement can normalise prolactin levels.
  • Observation: If idiopathic or mild, the condition may be managed with regular follow-up and monitoring of symptoms and prolactin levels.
• Specialist Care:
  • Dopamine Agonists: Medications such as cabergoline or bromocriptine may be prescribed to lower prolactin levels, particularly in cases of prolactinoma.
  • Surgical Intervention: Surgery may be indicated for large or symptomatic prolactinomas that do not respond to medical therapy.
  • Radiation Therapy: Rarely used, but may be considered in cases of aggressive pituitary tumours unresponsive to other treatments.

References

1. NHS (2024) Galactorrhoea: Causes, Symptoms, and Treatment. Available at: https://www.nhs.uk/conditions/galactorrhoea/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Hyperprolactinaemia and Galactorrhoea: Assessment and Management. Available at: https://cks.nice.org.uk/topics/hyperprolactinaemia/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Management of Hyperprolactinaemia and Associated Galactorrhoea. Available at: https://www.bmj.com/content/350/bmj.h4500 (Accessed: 24 June 2024).
4. American Academy of Family Physicians (2024) Diagnosis and Management of Galactorrhoea and Hyperprolactinaemia. Available at: https://www.aafp.org/afp/2024/0624/p4500.html (Accessed: 24 June 2024).

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