Galactorrhea, also known as hyperprolactinemia, is inappropriate breast milk secretion. It generally occurs 3 to 6 months after the discontinuation of breast-feeding (usually after a first delivery). It may also follow an abortion or may develop in a female who hasn’t been pregnant; it rarely occurs in males.
Galactorrhea usually develops in a person with increased prolactin secretion from the anterior pituitary gland, with possible abnormal patterns of secretion of growth, thyroid, and adrenocorticotropic hormones. However, increased prolactin serum concentration doesn’t always cause galactorrhea.
Additional factors that may precipitate this disorder include the following:
❑ endogenous: pituitary (high incidence with chromophobe adenoma), ovarian, or adrenal tumors and hypothyroidism; in males, pituitary, testicular, or pineal gland tumors
❑ idiopathic: possibly from stress or anxiety, which causes neurogenic depression of the prolactin-inhibiting factor
❑ exogenous: breast stimulation, genital stimulation, or drugs (such as hormonal contraceptives, meprobamate, and phenothiazines).
In the female with galactorrhea, milk continues to flow after the 21-day period that’s normal after weaning. Galactorrhea may also be spontaneous and unrelated to normal lactation, or it may be caused by manual expression. Such abnormal flow is usually bilateral and may be accompanied by amenorrhea.
Characteristic clinical features and the patient history (including drug and sex histories) confirm galactorrhea.
Laboratory tests to help determine the cause include measurement of serum levels of prolactin, cortisol, thyroid-stimulating hormone, triiodothyronine, and thyroxine. A computed tomography scan and, possibly, mammography may also be indicated.
Treatment varies according to the underlying cause and ranges from simple avoidance of precipitating exogenous factors such as drugs to treatment of tumors with surgery, radiation, or chemotherapy.
Therapy for idiopathic galactorrhea depends on whether the patient plans to have more children. If she does, treatment usually consists of bromocriptine; if she doesn’t, oral estrogens such as ethinyl estradiol and progestins such as progesterone effectively treat this disorder. Idiopathic galactorrhea may recur after discontinuation of drug therapy.
❑ Watch for central nervous system abnormalities, such as headache, failing vision, and dizziness.
❑ Maintain adequate fluid intake, especially if the patient has a fever. However, advise the patient to avoid tea, coffee, and certain tranquilizers that may aggravate engorgement.
❑ Instruct the patient to keep her breasts and nipples clean.
❑ Tell the patient who’s taking bromocriptine to report nausea, vomiting, dyspepsia, appetite loss, dizziness, fatigue, numbness, and hypotension. To prevent GI upset, advise her to eat small meals frequently and to take this drug with dry toast or crackers. After treatment with bromocriptine, milk secretion usually stops in 1 to 2 months, and menstruation recurs after 6 to 24 weeks.
Review other book chapters online related to Ahumada-Del Castillo Syndrome:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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