Galactorrhea
Galactorrhea: Excerpt from Professional Guide to Diseases (Eighth Edition)
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.
Causes
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).
Signs and symptoms
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.
Diagnosis
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
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.
Special considerations
❑ 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.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Amenorrhea (Professional Guide to Diseases (Eighth Edition))
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