Overview

Galactorrhea is a condition characterized by the spontaneous flow of a milky discharge from the nipple, unrelated to breastfeeding or childbirth. It can occur in both women and, less commonly, in men and children. While galactorrhea itself is not a disease, it often signals an underlying hormonal imbalance or other medical condition. Although usually benign, persistent or unexplained galactorrhea warrants medical evaluation to rule out serious causes, such as pituitary gland disorders or certain medications. Proper identification and treatment of the underlying cause typically resolve the symptoms.

Causes

Galactorrhea results from elevated levels of prolactin, the hormone responsible for milk production. Common causes include:

• Hormonal Imbalances: Hyperprolactinemia (elevated prolactin levels) is the primary hormonal cause, often linked to pituitary gland dysfunction.
• Pituitary Tumors: A prolactinoma, a benign tumor of the pituitary gland, is a frequent cause of galactorrhea.
• Medications: Certain drugs, including antipsychotics, antidepressants, blood pressure medications, and hormonal contraceptives, can trigger galactorrhea.
• Hypothyroidism: An underactive thyroid can elevate prolactin levels, leading to galactorrhea.
• Breast Stimulation: Frequent nipple stimulation from sexual activity or self-examination can sometimes cause galactorrhea.
• Chronic Kidney Disease: Impaired kidney function may reduce prolactin clearance from the body.
• Stress: Severe emotional stress can occasionally lead to hormonal fluctuations causing nipple discharge.
• Idiopathic Galactorrhea: In some cases, no specific cause is identified.

Symptoms

The primary symptom of galactorrhea is the presence of milky nipple discharge, but other symptoms may accompany it depending on the underlying cause:

• Milky Nipple Discharge: Discharge can occur from one or both nipples, spontaneously or when pressed.
• Irregular Menstrual Cycles: Women may experience missed or irregular periods due to hormonal imbalances.
• Breast Tenderness: Some individuals report breast fullness or tenderness.
• Headaches or Vision Problems: Associated with pituitary tumors that press on surrounding structures.
• Decreased Libido: Hormonal imbalances may cause reduced sexual desire, especially in men.
• Infertility: Elevated prolactin can interfere with ovulation, contributing to fertility issues in women.

Diagnosis

Diagnosing galactorrhea involves a thorough evaluation to determine the cause of the abnormal discharge:

• Medical History: Includes reviewing medication use, menstrual patterns, and any recent stress or breast stimulation.
• Physical Examination: Breast and neurological exams to identify any abnormal findings.
• Blood Tests: Measurement of prolactin levels, thyroid function (TSH), and kidney function to check for hormonal and systemic causes.
• Pregnancy Test: To rule out pregnancy as a cause of nipple discharge.
• MRI of the Brain: If prolactin levels are high, an MRI may be ordered to detect pituitary tumors.
• Mammography or Ultrasound: In certain cases, imaging may be done to exclude breast pathology.

Treatment

Treatment of galactorrhea focuses on addressing the underlying cause to stop the inappropriate milk production:

• Discontinuing Medications: Switching or stopping medications that cause galactorrhea can resolve symptoms.
• Managing Underlying Conditions: Treating hypothyroidism with thyroid hormone replacement or kidney disease can normalize prolactin levels.
• Medications: Dopamine agonists such as bromocriptine or cabergoline effectively lower prolactin levels, especially in prolactinoma cases.
• Monitoring Pituitary Tumors: Small, non-symptomatic prolactinomas may be monitored without immediate treatment.
• Surgical Intervention: Rarely required, but large pituitary tumors causing severe symptoms may need surgical removal.
• Lifestyle Adjustments: Reducing nipple stimulation and managing stress may help in mild cases of galactorrhea.

Prognosis

The prognosis for galactorrhea is generally favorable, especially when the underlying cause is effectively treated:

• Excellent with Treatment: Most individuals see resolution of symptoms after appropriate therapy, especially in medication-related or hormonal cases.
• Good for Prolactinomas: Dopamine agonists effectively shrink tumors and normalize prolactin levels in most cases.
• Fertility Restoration: Women with infertility due to high prolactin often regain normal fertility after treatment.
• Low Risk of Complications: Serious complications are uncommon, though large untreated tumors can cause vision problems or persistent hormonal issues.
• Monitoring Required: Periodic follow-up may be necessary to monitor prolactin levels and prevent recurrence.

With timely diagnosis and proper management, individuals with galactorrhea can expect excellent outcomes and a return to normal quality of life.