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- 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
Most cases of galactorrhea during pregnancy are physiologic.
- 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)
6.8% of women referred to physicians with a breast complaint have nipple discharge.
- Frequent nipple stimulation can cause galactorrhea.
- Keep medication causes in mind.
Disorders of lactation are associated with elevated prolactin levels, either from overproduction or loss of inhibitory regulation by dopamine.
- Nipple stimulation
- Pituitary gland overproduction:
- Loss of dopamine via hypothalamic dysregulation:
- Meningiomas or other tumors
- Vascular insult
- Stalk disruption
- Traumatic injury
- Medications that suppress dopamine:
- Typical and atypical antipsychotics
- Tricyclic antidepressants
- Protease inhibitors (1)
- Chest wall injury:
- Zoster, surgical or other trauma
- Postoperative condition, especially oophorectomy
- Renal failure
- Other causes:
- Primary hypothyroidism
- Cushing disease
- Ectopic prolactin secretion
- Renal failure
- Multiple sclerosis
- Polycystic ovary syndrome
- Normal prolactin levels
Commonly Associated Conditions