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Galactorrhea


Introduction

  • Description: Spontaneous, bilateral nipple discharge (milky fluid only) unrelated to pregnancy or breastfeeding.

  • Prevalence: Uncommon, but reports vary from 1%–30%, depending on the population studied.

  • Predominant Age: Reproductive age.

  • Genetics: No genetic pattern.

Etiology and Pathogenesis

  • Causes: Pituitary adenoma (generally <10 mm), disruptions in thyroid or prolactin hormone levels, pharmacologic (most often those drugs that affect dopamine or serotonin), second-generation histamine 2 receptor antagonists (cimetidine), autoimmune disease (sarcoid, lupus), Cushing disease, herpes zoster, chest wall/breast stimulation or irritation, physiologic changes during pregnancy or after childbirth and/or breastfeeding, specific foods (licorice). No cause may be found in up to 50% of cases.

  • Risk Factors: None known.

Signs and Symptoms

  • Bilateral, spontaneous, milky discharge from both breasts

  • Often symptoms of underlying pathologic condition (eg, hypothyroidism, Cushing disease, or pituitary enlargement)

  • Amenorrhea common

Diagnostic Approach

Differential Diagnosis

  • Pregnancy

  • Breast cancer

  • Chronic nipple stimulation

  • Hypothyroidism

  • Sarcoidosis

  • Lupus

  • Cirrhosis or hepatic disease

  • Associated Conditions: One-third of patients with an elevated prolactin level experience amenorrhea or infertility. Prolonged amenorrhea is associated with an increased risk for osteoporosis, vaginal and genital atrophic changes, dyspareunia, and libidinal dysfunction.

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