Galactorrhea

Galactorrhea
Classification and external resources
ICD-10	N64.3, O92.6
ICD-9	611.6, 676.6
DiseasesDB	6314
MeSH	D005687

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

Galactorrhea is reported to occur in 5%-32% percent of women, much of the difference in reported incidence can be attributed to different definitions of galactorrhea. Galactorrhea also occurs in males, newborn infants and adolescents of both sexes.

Although frequently benign, it may be caused by serious underlying conditions and should be properly investigated.

Causes

It can be due to dysregulation of certain hormones or local causes such as excessive nipple stimulation. Hormonal causes most frequently associated with galactorrhea are hyperprolactinemia and thyroid conditions with elevated levels of TSH or TRH hormones. No obvious cause is found in about 50% of cases.

Lactation requires the presence of estrogen, progesterone and prolactin, and the evaluation of galactorrhoea includes eliciting a history for various medications or foods (methyldopa, opiates, antipsychotics, serotonin reuptake inhibitors, as well as licorice^{[citation needed]}) 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. Galactorrhoea may also be caused by hormonal imbalances owing to birth control pills.

Galactorrhoea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine (trade name: Tagamet). Galactorrhoea can be also caused by anti-psychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Of these, risperidone is the most notorious for causing this complication. Case reports suggest proton-pump inhibitors have been shown to cause Galactorrhoea.

Neonatal Milk

Neonatal milk or witch's milk is milk secreted from the breasts of many newborn infants. It is caused by a combination of the effects of maternal hormones before birth, prolactin and growth hormone passed through breast feeding and the postnatal pituitary and thyroid hormone surge in the infant. Witch's milk is more likely to be secreted by infants born at full term, than by prematurely-born infants. Breast milk production occurs in about 5% of newborns and can persist for two months though palpable breast buds can persist into childhood.

Blood from the nipples is nearly always benign and associated with the normal growth of the ducts, rather than mastitis. In extremely rare cases mastitis may develop. Removing the milk from the breasts can prolong milk production and is customary in some cultures but considered harmful by medical professionals. While breastfeeding may also contribute to prolonged milk production and breast enlargement, temporary or permanent weaning is not recommended.

In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirits.

See also

• Galactagogue, a substance that promotes lactation in humans and other animals

External links

• familydoctor.org has a good overview of galactorrhea.
• http://www.calgaryhealthregion.ca/breasthealth/common_breast_conditions/gynecomastia_male.htm
• MR images Galactorrhea and Pituitary tumors (microadenoma)