Galactorrhea

Overview
Galactorrhea or galactorrhoea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing.

Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "nipple discharge."

Common Causes
It can be due to dysregulation of certain hormones or local causes such as excessive nipple stimulation.

Lactation requires the presence of estrogen, progesterone and prolactin, and the evaluation of galactorrhea includes eliciting a history for various medications or foods (methyldopa, opiates, some typical antipsychotics, as well as licorice) and for behavioral causes (stress, and breast and chest wall stimulation), as well as evaluation for pregnancy, pituitary adenomas (with overproduction of prolactin or compression of the pituitary stalk), and hypothyroidism. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and infertility, which may be a diagnostic clue. Galactorrhea may also be caused by hormonal imbalances owing to birth control pills.

Galactorrhea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine (trade name: Tagamet).

Differential Diagnosis
In alphabetical order.


 * Drugs
 * Fibrocystic Disease
 * Hyperprolactinemia
 * Idiopathic (with menses)
 * Inflammation
 * Intraductal papilloma
 * Malignant neoplasm
 * Oral contraceptives
 * Recently preceded pregnancy
 * Trauma