Materiały źródłowe

• #1 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  A more recent article on galactorrhea is available. […] After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure. […] Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated. […] The underlying cause of galactorrhea should be treated when possible. […] The decision to treat patients with galactorrhea is based on the serum prolactin level, the severity of galactorrhea, and the patients fertility desires. […] Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders.

• #2 Galactorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537115/

  Galactorrhea is milk production from the breast unrelated to pregnancy or lactation. Milk production one year after cessation of breastfeeding is non-lactational and is considered galactorrhea. Various hormones including prolactin, estrogens, thyrotropin-releasing hormone (TRH) can affect the production of milk. This activity reviews the evaluation of galactorrhea and the role of the interprofessional team in treating this condition. […] Galactorrhea is milk production from the breast unrelated to pregnancy or lactation. Milk production one year after cessation of breastfeeding is non-lactational and is considered galactorrhea. Various hormones including prolactin, estrogens, thyrotropin-releasing hormone (TRH) can affect the production of milk. […] Careful assessment of hyperprolactinemic related symptoms menstrual irregularities, decreased libido, galactorrhea, erectile dysfunction, infertility, and gynecomastia should be performed.

• #3

  https://step1.medbullets.com/evidence/15317441

  After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure. Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated. The underlying cause of galactorrhea should be treated when possible. The decision to treat patients with galactorrhea is based on the serum prolactin level, the severity of galactorrhea, and the patient’s fertility desires. Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders. Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. Surgical resection rarely is required for prolactinomas.

• #4 Galactorrhea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/galactorrhea/diagnosis-treatment/drc-20350434

  For galactorrhea, possible questions to ask include: […] What tests might I need? […] Your healthcare professional may ask you questions, such as: […] What color is your nipple discharge? […] What medications do you take? […] Until your appointment, follow these tips to deal with unwanted nipple discharge: […] Don’t handle your breasts. This can help to ease nipple discharge. For instance, don’t rub your nipples during sex. Don’t wear clothing that rubs on your nipples.

• #5 Galactorrhea | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/galactorrhea

  It can be hard to find the cause of galactorrhea because there are so many possible reasons for it. […] Testing may involve: A physical exam. A healthcare professional may try to get some of the fluid from the nipple by gently squeezing the area around the nipple. This exam may include looking for breast lumps or other areas of thickened breast tissue. A blood test. This is to check the level of prolactin in your system. If your prolactin level is high, your healthcare professional may check your thyroid-stimulating hormone level, too. A pregnancy test. This is to rule out pregnancy as a cause of nipple discharge. Diagnostic mammography, ultrasound or both. You may have these imaging tests if your healthcare professional finds a breast lump or sees other breast or nipple changes during your physical exam. MRI of the brain. This is to check for a tumor or other issue of your pituitary gland if your blood test shows a high prolactin level.

• #6 Galactorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537115/

  For assessing galactorrhea on physical exam, the patient needs to be sitting and leaning forward. The areola needs to be squeezed in the direction of the nipple. The galactorrhea is usually bilateral and can be white or green. […] Prolactin levels need to be taken at least once in the evaluation of hyperprolactinemia. Prolactin levels are measured using a sandwich ELISA assay where a prolactin molecule needs to bind to a capture as well as a detection antibody to be measured. […] After ruling out breast pathologies, therapy direction is towards the cause of hyperprolactinemia. Hyperprolactinemia is treated if there is a pituitary lesion or hypogonadism with problematic galactorrhea; if not troublesome, it can be monitored without therapy. […] The mainstay of hyperprolactinemia is treatment with bromocriptine or cabergoline. These are dopamine agonists which act on the D2 receptors present on the lactotrophs and inhibit prolactin production.

• #7 Galactorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Galactorrhea/item/305

  Galactorrhea may be intermittent or continuous, bilateral or unilateral, and free-flowing or expressible. By definition, fat droplets must be present on microscopic examination for a breast secretion to be considered milk and thus evidence of galactorrhea. Galactorrhea is frequently associated with hyperprolactinemia, and serum levels are evaluated by radioimmunoassay. Prolactin exists in several isoforms, including glycosylated prolactin, big prolactin, and big-big prolactin. Native prolactin (monomeric) appears to have the greatest biologic activity. […] The patient who presents with galactorrhea should undergo an extensive history and physical examination to determine the cause of the problem. A serum prolactin level should be measured because the absolute level is often predictive of the type of pathology. For instance, a pituitary tumor is found 25% of the time with a prolactin level of 50 ng/mL, 50% of the time with a level of 100 ng/mL, and almost 100% of the time with a level of 200 ng/mL. Drug intake rarely produces hyperprolactinemia above 60 ng/mL.

• #8 Galactorrhea

  https://www.mymlc.com/health-information/diseases-and-conditions/g/galactorrhea/?section=Treatment

  Galactorrhea (guh-lack-toe-REE-uh) is a milky nipple discharge unrelated to the normal milk production of breast-feeding. Galactorrhea itself isn’t a disease, but it could be a sign of an underlying problem. It usually occurs in women, even those who have never had children or after menopause. But galactorrhea can happen in men and even in infants. […] Finding the underlying cause of galactorrhea can be a complex task because there are so many possibilities. […] Testing may involve: A physical exam, during which your doctor may try to express some of the fluid from your nipple by gently examining the area around your nipple. Your doctor may also check for breast lumps or other suspicious areas of thickened breast tissue. Analysis of fluid discharged from the nipple, to see if fat droplets are present in the fluid, which can help confirm the diagnosis of galactorrhea. A blood test, to check the level of prolactin in your system. If your prolactin level is elevated, your doctor will most likely check your thyroid-stimulating hormone (TSH) level, too. A pregnancy test, to exclude pregnancy as a possible cause of nipple discharge. Mammography, ultrasound or both, to obtain images of your breast tissue if your doctor finds a breast lump or observes other suspicious breast or nipple changes during your physical exam. Magnetic resonance imaging (MRI) of the brain, to check for a tumor or other abnormality of your pituitary gland if your blood test reveals an elevated prolactin level.

• #9 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. […] Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. […] Magnetic resonance imaging of the pituitary fossa should be performed if the serum prolactin level is significantly elevated or if there is any suspicion of a pituitary tumor. […] Galactorrhea is a discharge of milk or a milk-like secretion from the breast in the absence of parturition or beyond six months post-partum in a nonbreastfeeding woman. […] A milky discharge is characteristic of galactorrhea. […] Galactorrhea usually is bilateral, whereas a pathologic discharge usually is unilateral. […] If the diagnosis is not obvious, levels of serum prolactin, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone should be measured.

• #10 Galactorrhea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/galactorrhea/diagnosis-treatment/drc-20350434

  It can be hard to find the cause of galactorrhea because there are so many possible reasons for it. […] Testing may involve: […] A blood test. This is to check the level of prolactin in your system. If your prolactin level is high, your healthcare professional may check your thyroid-stimulating hormone level, too. […] MRI of the brain. This is to check for a tumor or other issue of your pituitary gland if your blood test shows a high prolactin level. […] When needed, galactorrhea treatment aims to resolve the underlying cause. […] Sometimes healthcare professionals can’t find an exact cause of galactorrhea. Then you may have treatment if your nipple discharge bothers you. A medicine that blocks the effects of prolactin or lowers your body’s prolactin level could help get rid of galactorrhea.

• #11 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  There is a direct correlation between the degree of hyperprolactinemia and the likelihood of finding a prolactin-secreting pituitary tumor. […] A serum prolactin level greater than 200 ng per mL (200 mcg per L) virtually assures the presence of a prolactinoma. […] Treatment of galactorrhea should be directed at the underlying cause. […] The decision to treat galactorrhea should be based on the serum prolactin level, the severity of the galactorrhea, and the patients fertility desires. […] In patients with hyperprolactinemia, prolactin levels should be monitored, and MRI should be performed every two years. […] Treatment goals include suppressing prolactin secretion and its clinical and biochemical consequences, reducing the size of the prolactinoma, and preventing its progression or recurrence.

• #12 Galactorrhea – Milky Nipple Discharge (or) Lactation In The Absence of Pregnancy

  https://www.medindia.net/health/conditions/galactorrhea.htm

  Galactorrhea is the spontaneous flow of milk from the breast in a woman who is not pregnant or nursing a child. […] The diagnosis of galactorrhea is based on the individual symptoms, medical history, medication use, and also ruling out pregnancy in a woman. […] Pregnancy test: to exclude pregnancy as a possible cause of nipple discharge. […] Analysis of fluid discharged from the nipple: Presence of fat droplets help confirm the diagnosis of galactorrhea. […] Measure prolactin levels: A blood test is done to measure the amount of prolactin in the blood. Prolactin levels above 25 nanogram/milliliter, in women who are not pregnant, are considered elevated. […] MRI of the Brain and Pituitary: to check for a tumor or other abnormality of the Pituitary gland, if your blood tests reveal an elevated Prolactin level.

• #13 Evaluation and Treatment of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0501/p1763.html

  Laboratory studies may include a serum pregnancy test, a prolactin level, renal function tests and a thyroid-stimulating hormone level. […] Imaging studies are also important in the evaluation of abnormal lactation. If the patient has symptoms suggestive of an intracranial mass, galactorrhea with amenorrhea, or an elevated prolactin level (greater than 20 ng per mL), magnetic resonance imaging (MRI) of the brain is indicated to detect a pituitary tumor or other intracranial lesion. […] The treatment of a prolactinoma depends on its size and the presence or absence of symptoms indicative of increased intracranial pressure or destruction of nearby structures. If the patient has a macroadenoma or symptoms such as headache or changes in vision, medical or surgical treatment is indicated.

• #14 Galactorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Galactorrhea/item/305

  Both CT and MRI scans are adequate for the diagnosis of both microadenomas and macroadenomas. Both of these radiographic techniques can detect a pituitary tumor as small as 2 mm. There is considerable difference in the cost of a CT and MRI scan. MRI scanning is advantageous if longitudinal surveillance is necessary over a lifetime because no radiation exposure is incurred with this technique. […] The primary mode of therapy for the treatment of functional hyperprolactinemia involves the use of dopamine agonists. Bromocriptine was the first compound approved for the treatment of hyperprolactinemia in the United States. This type of drug is an ergot derivative closely related to LSD. The dose range for the treatment of hyperprolactinemia with bromocriptine is 5-10 mg/day. However, subtherapeutic doses have often been shown to suppress prolactin levels and shrink pituitary tumors.

• #15 Hyperprolactinemia Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/121784-workup

  Generally, hyperprolactinemia is discovered in the course of evaluating a patient’s presenting complaint, for instance amenorrhea, galactorrhea, or erectile dysfunction. […] Pregnancy testing is required unless the patient is postmenopausal or has had a hysterectomy. […] Patients with macroadenoma should be evaluated for possible hypopituitarism. […] MRI is the imaging study of choice. MRI can detect adenomas that are as small as 3-5 mm.

• #16 Galactorrhea (milk flow) – Find a senology specialist!

  https://www.leading-medicine-guide.com/en/illness/genitourinary/galactorrhea

  Galactorrhea describes a discharge of secretions or milk from the nipple without the woman being pregnant or breastfeeding a child. Experts refer to milky discharge from the mammary gland outside of breastfeeding as galactorrhea. Below you will find information on the diagnosis and treatment of galactorrhea as well as specialists for the treatment of galactorrhea. […] Diagnosis – How doctors determine the cause of galactorrhea. If you discover a discharge from your nipples, you should urgently consult a doctor. Only a doctor can make the correct diagnosis and initiate the appropriate treatment. Your GP will refer you to a specialist if necessary. The doctor will primarily examine your blood to determine whether you have an elevated prolactin level. He will often also check the levels of oestrogen and progestin in women and testosterone in men. Your doctor will ask you what medication you are taking. This will enable him to determine whether galactorrhea is a side effect of a medication. If the prolactin level in the blood is too high, he will use a computer tomography or magnetic resonance imaging to check whether a prolactinoma is present. If the secretions are only on one side, a mammogram or an X-ray examination of the milk ducts with contrast medium is usually carried out. A mammary duct endoscopy or a cell examination may also be considered. […] Doctors classify galactorrhea into four different grades: In grade 1, only a few drops of secretion are present; In grade 2, at least one milliliter of fluid can be squeezed out; In grade 3, there are intermittent, unpredictable discharges; In grade 4, there is a constant flow of milk.

• #17 Nipple discharge – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/nipple-discharge/

  Nipple discharge can be physiological or pathological. Physiological discharge is typically bilateral, multiductal, with a milky appearance; causes include lactation and galactorrhea. Pathological discharge is typically unilateral, uniductal, nonmilky, and spontaneous. The diagnostic approach to nipple discharge is based on clinical evaluation findings, including characteristics of the discharge and patient age. Further evaluation with imaging is required for all patients with red flags in nipple discharge. Treatment depends on the underlying cause. […] Galactorrhea: discharge unrelated to pregnancy or breastfeeding. […] Medication review for drugs that can cause galactorrhea. […] Perform a focused clinical evaluation in all patients, including for red flags in nipple discharge. […] Serum prolactin (in hyperprolactinemia). […] Galactorrhea: Advise avoidance of nipple stimulation and reassess in 3 months. […] Treatment of hyperprolactinemia.

• #18 Galactorrhea – TeleHealth Pharmacy

  https://telehealthpharmacy.com/galactorrhea/

  Galactorrhea is a discharge of milk-like substance from the breast that is not associated with breastfeeding after pregnancy. […] The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include: […] A sample of the breast discharge to look at under a microscope […] Blood tests to check hormone levels […] Pregnancy test […] Imaging tests to check for a pituitary gland tumor in the brain: MRI scan […] CT scan. […] If the discharge is not milky or contains blood, then this is not galactorrhea. Other tests must be done to check for breast cancer or other disorders.

• #19 Galactorrhea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/galactorrhea/symptoms-causes/syc-20350431

  Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin. […] If one or both breasts keep leaking milky discharge, and you’re not pregnant or breastfeeding, make an appointment to see your healthcare professional. […] If you keep having discharge that doesn’t go away, make an appointment with your healthcare professional. […] Nipple discharge that isn’t milky needs medical attention right away. If the discharge is bloody, or clear and comes from one duct or there’s a lump you can feel, it may be a sign of breast cancer. […] Sometimes healthcare professionals can’t find a cause for galactorrhea. This is called idiopathic galactorrhea. This may mean that the breast tissue is very sensitive to the milk-making hormone prolactin. If so, even typical prolactin levels can lead to galactorrhea.

• #20 Galactorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22024

  Galactorrhea is milk production from the breast unrelated to pregnancy or lactation. Milk production one year after cessation of breastfeeding is non-lactational and is considered galactorrhea. Various hormones including prolactin, estrogens, thyrotropin-releasing hormone (TRH) can affect the production of milk. […] The various causes of galactorrhea broadly divide into hypothalamic-pituitary causes and non-hypothalamic-pituitary causes. […] Prolactin levels need to be taken at least once in the evaluation of hyperprolactinemia. Prolactin levels are measured using a sandwich ELISA assay where a prolactin molecule needs to bind to a capture as well as a detection antibody to be measured. […] After ruling out breast pathologies, therapy direction is towards the cause of hyperprolactinemia. Hyperprolactinemia is treated if there is a pituitary lesion or hypogonadism with problematic galactorrhea; if not troublesome, it can be monitored without therapy.

• #21 Prolactinoma – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/prolactinoma

  Prolactinomas are noncancerous tumors made up from lactotrophs in the pituitary gland. Diagnosis is by measurement of prolactin levels and imaging tests. Galactorrhea is generally due to a prolactin-secreting pituitary adenoma (prolactinoma) but may result from any cause of hyperprolactinemia. Diagnosis of galactorrhea due to a prolactin-secreting pituitary adenoma is based on elevated prolactin levels (typically 5 times normal, sometimes much higher.) Measure prolactin levels and do central nervous system imaging to detect a causative tumor. For microprolactinomas, give a dopamine agonist if certain troublesome symptoms are present. For macroadenomas, give a dopamine agonist and consider surgical ablation or sometimes radiation therapy when drugs fail to achieve treatment goals. […] Diagnosis is by measurement of prolactin levels and imaging tests.

• #22

  https://journals.lww.com/plasreconsurg/fulltext/2021/05000/galactorrhea_and_galactocele_after_breast.84.aspx

  Breast augmentation is one of the most performed cosmetic procedures in the world. Galactorrhea and galactoceles are rare complications seen after breast plastic surgery. […] The precise diagnosis and management of cases are challenging for the surgeon, because in many cases, the lack of papillary discharge associated with the collection around the implants can be confused with an infectious process leading to surgical removal of the implants. […] Faced with a case of postoperative galactorrhea, the level of prolactin must be measured and other causes of hyper prolactinemia must be excluded, such as prolactinomas, breastfeeding, pregnancy, use of contraceptives, use of dopamine-inhibiting drugs (e.g., neuroleptics, tricyclic antidepressants, and some antihypertensive drugs), hypothyroidism, adrenal insufficiency, renal or hepatic insufficiency, and polycystic ovary syndrome.

• #23 Galactorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Galactorrhea/item/305

  Galactorrhea, the inappropriate production and secretion of milk, with its associated hyperprolactinemia, is an extremely common clinical entity. It is often accompanied by menstrual disturbance and infertility and may herald the presence of pituitary tumors, which can produce considerable morbidity and rarely mortality. The management of this condition has been greatly simplified with the advent of newer radiologic and radiochemical techniques. The natural history of pituitary tumors is much better understood today than 20 years ago, and management of these lesions is less conservative than in the past. […] Hyperprolactinemia is associated with numerous types of pathology. The four most common causes of hyperprolactinemia are central dopamine metabolism disturbance (functional hyperprolactinemia), prolactinomas, hypothyroidism, and drug ingestion. Patients with hypothyroidism deserve special comment. These patients present with compensated primary hypothyroidism and may demonstrate a normal thyroxine level with markedly elevated TSH levels. They often have pituitary enlargement mimicking an adenoma and may have visual impairment. It is necessary to evaluate thyroid function in all patients before considering neurosurgical exploration.

• #24 Galactorrhea | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688531/all/Galactorrhea

  Milky nipple discharge not associated with lactation, defined as 1 year after pregnancy or cessation of breastfeeding. […] Galactorrhea results either from prolactin overproduction or loss of inhibitory regulation by dopamine. […] Approximately 20-25% of women experience galactorrhea in their lifetime. […] Commonly associated with hypothyroidism, chronic kidney disease, hypogonadism, and pituitary adenoma.

• #25 Galactorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537115/

  Normoprolactinemic galactorrhea occurs when the galactorrhea accompanies normal prolactin levels. If symptomatic with troublesome galactorrhea or menstrual cycle irregularities it can be treated with dopamine agonists to obtain symptomatic relief. The treatment is tapered off once the galactorrhea has resolved. […] Galactorrhea is nonlactational production of milk. Prolactin, estrogens, and TRH all play a role in the production of milk from the breast. The condition is often managed by an interprofessional team that consists of a radiologist, endocrinologist, neurosurgeon, neurologist, and an internist.

• #26 Galactorrhoea – TeachMeSurgery

  https://teachmesurgery.com/breast/presentations/galactorrhoea/

  Galactorrhoea is defined as is defined as copious, bilateral, multi-ductal, milky discharge, not associated with pregnancy or lactation. […] Galactorrhoea occurs almost exclusively in females and most commonly in adults, however rarely may be seen in male infants secondary to maternal oestrogen exposure. […] Hyperprolactinaemia is the most common cause. […] Normoprolactinaemic galactorrhoea is less common and is typically idiopathic, the diagnosis only being made once all other causes of galactorrhoea have been excluded (i.e. normal blood markers and regular menstruation). […] It is important to determine the presence of true galactorrhoea (multi-ductal milky white nipple discharge, typically bilateral), not alternative nipple discharge that could signal an alternative diagnosis. […] Patients should have serum prolactin levels checked, with complete thyroid function, liver function, and renal function tests.

• #27 Evaluation and Treatment of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0501/p1763.html

  Galactorrhea, or inappropriate lactation, is a relatively common problem that occurs in approximately 20 to 25 percent of women. […] The differential diagnosis of galactorrhea includes pituitary adenomas, neurologic disorders, hypothyroidism, numerous medications, breast stimulation, chest wall irritation and physiologic causes. The evaluation includes a thorough history and physical examination, as well as selected laboratory and imaging studies to rule out secondary causes such as an intracranial mass or a tumor. Diagnostic studies include a pregnancy test, a prolactin level, renal and thyroid function tests and, if indicated, magnetic resonance imaging of the brain. […] The evaluation of galactorrhea includes a thorough history and physical examination. Selected laboratory tests and imaging studies are also important.

• #28 MD Consult – Book Text

  https://www.rima.org/web/bcmonline/16339.html

  Galactorrhea may be defined as any persistent discharge of milk or milk-like secretions from the breast in the absence of parturition or beyond 6 mo post partum in a non-nursing mother. […] The most important diagnostic consideration in galactorrhea is pituitary tumor. […] The true prevalence of tumors is undoubtedly higher than these figures indicate because of failure to detect some small microadenomas before the availability of computed tomographic (CT) scans and magnetic resonance imaging (MRI). […] From a clinical standpoint, the combination of regular menses and normal serum prolactin is strong evidence against the presence of pituitary tumor. […] A careful history is essential, with attention to menses, drug ingestion, and symptoms suggestive of pituitary or hypothalamic disease.

• #29 Diagnosis and Management of Galactorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html

  Dopamine agonists are the preferred treatment for most patients with hyperprolactinemic disorders; these agents are extremely effective in lowering serum prolactin levels, eliminating galactorrhea, restoring gonadal function, and decreasing tumor size. […] Bromocriptine and cabergoline are the only dopamine agonists approved by the U.S. Food and Drug Administration for the treatment of hyperprolactinemia. […] Because of the inherent risks of surgery and the efficacy of dopamine agonists in treating patients with prolactinoma, surgical resection rarely is required.

• #30 Prolactinoma – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/prolactinoma

  Diagnosis of galactorrhea due to a prolactin-secreting pituitary adenoma is based on elevated prolactin levels (typically 5 times normal, sometimes much higher.) […] Measure prolactin levels and do central nervous system imaging to detect a causative tumor. […] For microprolactinomas, give a dopamine agonist if certain troublesome symptoms are present. […] For macroadenomas, give a dopamine agonist and consider surgical ablation or sometimes radiation therapy when drugs fail to achieve treatment goals.

• #31 Galactorrhea and Headaches in a Nonpregnant Woman

  https://www.patientcareonline.com/view/galactorrhea-and-headaches-nonpregnant-woman

  Treatment is indicated in patients with symptoms of hypogonadism and/or neurological impairment. Medical therapy is the treatment of choice for most prolactinomas; surgery is rarely needed. […] The goals of treatment are: To lower prolactin levels. To decrease tumor size. To reduce galactorrhea. To restore menses and fertility. […] Regardless of their size, prolactinomas are initially treated with dopamine agonists, such as bromocriptine or cabergoline.

• #32 What Do You Do If You Have Galactorrhea? Causes & Treatment

  https://www.medicinenet.com/what_do_you_do_if_you_have_galactorrhea/article.htm

  Galactorrhea often results from excess production of prolactin, which is a hormone secreted by your pituitary gland. Your doctor will perform a physical examination of your breast, pressing your nipples to look at the discharge and feeling for any lumps or hardness in your breast. They may also order tests including: […] Blood tests to check for elevated prolactin level or thyroid-stimulating hormone (TSH) level. […] Your doctor may recommend treatment depending on the underlying cause of the condition. Treatment may include: Discontinuing medications that may be causing galactorrhea as a side effect and prescribing an alternative medication in its place. […] Prescribing medications that target prolactin production in your body such as: Levothyroxine for hypothyroidism (underactive thyroid).

• #33 Galactorrhea: Understanding Causes, Symptoms, Diagnosis, and Treatment – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/galactorrhea-understanding-causes-symptoms-diagnosis-and-treatment

  If galactorrhea is a side effect of certain medications, healthcare professionals may consider adjusting the dosage or switching to alternative medications. […] For galactorrhea related to stress and emotional factors, stress management techniques, counseling, and relaxation exercises may be recommended. […] Avoiding excessive nipple stimulation and wearing comfortable, non-irritating clothing can help minimize nipple sensitivity and reduce galactorrhea symptoms.

• #34 Hyperprolactinaemia and galactorrhoea with combined oral contraceptive pill use: A refresher

  https://www1.racgp.org.au/ajgp/2022/june/hyperprolactinaemia-and-galactorrhoea

  Serum prolactin levels should be measured after fasting, but can be measured at any time of the day. […] A single raised prolactin level should always be repeated. […] To confirm galactorrhoea, the nipple discharge should be collected and tested for fat globules. […] COCP cessation should eventually result in long-term galactorrhoea improvement if it is related to the COCP. […] It is important that the patient is part of their management and to educate the patient on other possible adverse effects of hyperprolactinaemia, such as infertility, sexual dysfunction and osteoporosis. […] High oestrogen COCPs can result in hyperprolactinaemia and galactorrhoea. Switching to a lower-dose COCP or a progesterone-only pill is a reasonable option to consider. […] Thyroid dysfunction-induced hyperprolactinaemia should resolve with thyroxine use.

• #35 Galactorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22024

  The mainstay of hyperprolactinemia is treatment with bromocriptine or cabergoline. These are dopamine agonists which act on the D2 receptors present on the lactotrophs and inhibit prolactin production. […] Normoprolactinemic galactorrhea occurs when the galactorrhea accompanies normal prolactin levels. If symptomatic with troublesome galactorrhea or menstrual cycle irregularities it can be treated with dopamine agonists to obtain symptomatic relief.

• #36 Galactorrhea

  https://www.mymlc.com/health-information/diseases-and-conditions/g/galactorrhea/?section=Treatment

  When needed, galactorrhea treatment focuses on resolving the underlying cause. Sometimes doctors can’t determine an exact cause of galactorrhea. Your doctor might recommend treatment anyway if you have bothersome or persistent nipple discharge. A medication that blocks the effects of prolactin or lowers your body’s prolactin level could help eliminate galactorrhea.

• #37 Galactorrhea // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/galactorrhea

  Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin. […] It can be hard to find the cause of galactorrhea because there are so many possible reasons for it. […] Testing may involve: A blood test. This is to check the level of prolactin in your system. If your prolactin level is high, your healthcare professional may check your thyroid-stimulating hormone level, too. […] When needed, galactorrhea treatment aims to resolve the underlying cause. […] Sometimes healthcare professionals can’t find an exact cause of galactorrhea. Then you may have treatment if your nipple discharge bothers you. A medicine that blocks the effects of prolactin or lowers your body’s prolactin level could help get rid of galactorrhea. […] Your healthcare professional may ask you questions, such as: What tests might I need? […] Until your appointment, follow these tips to deal with unwanted nipple discharge: Don’t handle your breasts. This can help to ease nipple discharge.

• #38 Galactorrhoea: Causes and Treatment | Doctor

  https://patient.info/doctor/galactorrhoea

  Identify and treat the cause, if possible: […] Treat hypothyroidism. […] Management of prolactinomas is described in the separate Hyperprolactinaemia article. […] Review/change any contributing drugs. […] If the cause cannot be addressed, consider: […] Dopamine agonists such as bromocriptine or cabergoline – treatment details are also in the Hyperprolactinaemia article. […] These dopamine agonists may also be used in those with normal PRL levels if galactorrhoea is troublesome and reassurance alone is not sufficient. This usually resolves the galactorrhoea within two months and the medication can then be stopped. […] Hormone treatment: testosterone for men or oestrogens for women (eg, the combined oral contraceptive pill). These help to prevent osteoporosis and may improve symptoms. […] Complications and prognosis […] These depend on the underlying cause. There is probably an increased risk of osteoporosis if hyperprolactinaemia is untreated.

• #39 Galactorrhea | Obgyn Key

  https://obgynkey.com/galactorrhea-2/

  Spontaneous, bilateral nipple discharge (milky fluid only) is called galactorrhea. […] Bilateral, spontaneous, milky discharge from both breasts Often symptoms of underlying pathologic condition (e.g., hypothyroidism, Cushings disease, or pituitary enlargement) Amenorrhea common. […] One third of patients with an elevated prolactin level experience amenorrhea or infertility. Prolonged amenorrhea is associated with an increased risk of osteoporosis, vaginal and genital atrophic changes, dyspareunia, and libidinal dysfunction.

• #40 Galactorrhea Causes, Symptoms, Diagnosis and Treatment – Cura4U

  https://cura4u.com/conditions/galactorrhea

  Galactorrhea is a condition in which milk or milk-like discharge is flown spontaneously from the breast, which is not associated with pregnancy, childbirth, or breastfeeding. […] The management focuses on identifying and treating the underlying cause. […] Your healthcare provider will take a detailed history of your symptoms, associated conditions, pregnancy, medication use. He would then perform a physical examination with a special focus on the breasts and signs of a tumor in the brain via a thorough neurological examination. Discharge from the breasts can be expressed and sent for laboratory analysis to confirm breast milk. To confirm the diagnosis, the following tests can be performed; […] If you are having the symptoms of galactorrhea, be vigilant to consult your healthcare provider. They would try to find out the underlying cause to treat the condition and exclude a serious condition. […] When a pituitary tumor causes galactorrhea, the treatment will depend on the nature and effects of the tumor. […] Galactorrhea is not a life-threatening condition. If the causative factors are treated, it goes away on its own.

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