Galactorrhea

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Galactorrhea

Definition

Galactorrhea is the secretion of breast milk in men, or in women who are not breastfeeding an infant.

Description

Lactation, or the production of breast milk, is a normal condition occurring in women after delivery of a baby. Many women who have had children may even be able to express a small amount of breast milk from the nipple up to two years after childbirth. Galactorrhea, or hyperlactation, however, is a rare condition that can occur in both men and women, where a white or grayish fluid is secreted by the nipples of both breasts. While this condition is not serious in itself, galactorrhea can indicate more serious conditions, including hormone imbalances or the presence of tumors.

Causes and symptoms

Causes

Galactorrhea is associated with a number of conditions. The normal production of breast milk is controlled by a hormone called prolactin, which is secreted by the pituitary gland in the brain. Any condition that upsets the balance of hormones in the blood or the production of hormones by the pituitary gland or sexual organs can stimulate the production of prolactin.

Often, a patient with galactorrhea will have a high level of prolactin in the blood. A tumor in the pituitary gland can cause this overproduction of prolactin. At least 30% of women with galactorrhea, menstrual abnormalities, and high prolactin levels have a pituitary gland tumor. Other types of brain tumors, head injuries, or encephalitis (an infection of the brain) can also cause galactorrhea.

Tumors or growths in the ovaries or other reproductive organs in women, or in the testicles or related sexual organs of men, can also stimulate the production of prolactin. Any discharge of fluid from the breast after a woman has passed menopause may indicate breast cancer. However, most often the discharge associated with breast cancer will be from one breast only. In galactorrhea both breasts are usually involved. The presence of blood in the fluid discharged from the breast could indicate a benign growth in the breast tissue itself. In approximately 10-15% of patients with blood in the fluid, carcinoma of the breast tissue is present.

A number of medications and drugs can also cause galactorrhea as a side-effect. Hormonal therapies (like oral contraceptives ), drugs for treatment of depression or other psychiatric conditions, tranquilizers, morphine, heroin, and some medications for high blood pressure can cause galactorrhea.

Several normal physiologic situations can cause production of breast milk. Nipple stimulation in men or women during sexual intercourse may induce lactation, for women particularly during or just after pregnancy.

Even after extensive testing, no specific cause can be determined for some patients with galactorrhea.

Symptoms

The primary symptom of galactorrhea is the discharge of milky fluid from both breasts. In women, galactorrhea may be associated with infertility, menstrual cycle irregularities, hot flushes, or amenorrhea—a condition where menstruation stops completely. Men may experience loss of sexual interest and impotence. Headaches and visual disturbances have also been associated with some cases of galactorrhea.

Diagnosis

Galactorrhea is generally considered a symptom that may indicate a more serious problem. Collection of a thorough medical history, including pregnancies, surgeries, and consumption of drugs and medications is a first step in diagnosing the cause of galactorrhea. A physical examination, along with a breast examination, will usually be conducted. Blood and urine samples may be taken to determine levels of various hormones in the body, including prolactin and compounds related to thyroid function.

A mammogram (an x ray of the breast) or an ultrasound scan (using high frequency sound waves) might be used to determine if there are any tumors or cysts present in the breasts themselves. If a tumor of the pituitary gland is suspected, a series of computer assisted x rays called a computed tomography scan (CT scan) may be done. Another procedure that may be useful is a magnetic resonance imaging (MRI) scan to locate tumors or abnormalities in tissues.

Treatment

Treatment for galactorrhea will depend on the cause of the condition and the symptoms. The drug bromocriptine is often prescribed first to reduce the secretion of prolactin and to decrease the size of pituitary tumors. This drug will control galactorrhea symptoms and in many cases may be the only therapy necessary. Oral estrogen and progestins (hormone pills, like birth control pills) may control symptoms of galactorrhea for some women. Surgery to remove a tumor may be required for patients who have more serious symptoms of headache and vision loss, or if the tumor shows signs of enlargement despite drug treatment. Radiation therapy has also been used to reduce tumor size when surgery is not possible or not totally successful. A combination of drug, surgery, and radiation treatment can also be used.

Galactorrhea is more of a nuisance than a real threat to health. While it is important to find the cause of the condition, even if a tumor is discovered in the pituitary gland, it may not require treatment. With very small, slow-growing tumors, some physicians may suggest a "wait and see" approach.

Prognosis

Treatment with bromocriptine is usually effective in stopping milk secretion, however, symptoms may recur if drug therapy is discontinued. Surgical removal or radiation treatment may correct the problem permanently if it is related to a tumor. Frequent monitoring of hormone status and tumor size may be recommended.

Prevention

There is no way to prevent galactorrhea. If the condition is caused by the use of a particular drug, a patient may be able to switch to a different drug that does not have the side-effect of galactorrhea.