Galactorrhea
Galactorrhea was found in 5-Minute Clinical Consult which helps you diagnose, treat, and follow up on over 900 medical conditions seen in everyday practice.

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Basics

Description

  • Milky nipple discharge not associated with gestation or present >1 year after weaning. Galactorrhea does not include serous, purulent, or bloody nipple discharge.
  • System(s) affected: Endocrine/Metabolic, Nervous, Reproductive
  • Synonym(s): Disordered lactation; Nipple discharge

Pregnancy Considerations
Most cases of galactorrhea during pregnancy are physiologic.

Epidemiology

  • Predominant age: 15–50 years (reproductive age)
  • Predominant sex: Female > Male (rare, for example, in patients with multiple endocrine neoplasia type 1 [MEN1], the most common anterior pituitary tumors are prolactinomas)

Incidence
Common

Prevalence
6.8% of women referred to physicians with a breast complaint have nipple discharge.

General Prevention

  • Frequent nipple stimulation can cause galactorrhea.
  • Keep medication causes in mind.

Pathophysiology

Disorders of lactation are associated with elevated prolactin levels, either from overproduction or loss of inhibitory regulation by dopamine.

Etiology

  • Nipple stimulation
  • Pituitary gland overproduction:
    • Prolactinoma
  • Loss of dopamine via hypothalamic dysregulation:
    • Craniopharyngiomas
    • Meningiomas or other tumors
    • Sarcoid
    • Irradiation
    • Vascular insult
    • Stalk disruption
    • Traumatic injury
  • Medications that suppress dopamine:
    • Typical and atypical antipsychotics
    • SSRIs
    • Tricyclic antidepressants
    • Butyrophenones
    • Cimetidine
    • Ranitidine
    • Reserpine
    • α-methyldopa
    • Verapamil
    • Estrogens
    • Isoniazid
    • Opioids
    • Stimulants
    • Neuroleptics
    • Metoclopramide
    • Domperidone
    • Protease inhibitors (1)
  • Chest wall injury:
    • Zoster, surgical or other trauma
  • Postoperative condition, especially oophorectomy
  • Renal failure
  • Other causes:
    • Primary hypothyroidism
    • Cirrhosis
    • Cushing disease
    • Ectopic prolactin secretion
    • Renal failure
    • Sarcoid
    • Lupus
    • Multiple sclerosis
    • Polycystic ovary syndrome
  • Idiopathic:
    • Normal prolactin levels

Commonly Associated Conditions

See “Etiology.”

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