Galactorrhea is the inappropriate secretion of a liquid containing milk from the breast, which occurs in men or women who are not pregnant or breastfeeding. It is usually a symptom caused by increased prolactin, a hormone produced in the brain whose function is to induce the formation of milk by the breasts, a condition called hyperprolactinemia.
The main causes for the increase in prolactin are pregnancy and breastfeeding, and there are several causes for its inappropriate increase, including brain pituitary tumor, use of medications, such as some neuroleptics and antidepressants, breast stimulation or some endocrine diseases, such as hypothyroidism and polycystic ovary syndrome.
Thus, to treat hyperprolactinemia and galactorrhea, it is necessary to resolve its cause, either by removing a medication or treating a disease that is inducing the production of milk by the breasts.
Main causes
The main causes for breast milk production are pregnancy and breastfeeding, however, galactorrhea happens, mainly due to situations such as:
- Pituitary adenoma: it is a benign tumor of the pituitary gland, responsible for the production of several hormones, including prolactin. The main type is prolactinoma, which usually causes an increase in blood prolactin levels greater than 200mcg / L; Other changes in the pituitary gland: cancer, cyst, inflammation, irradiation or brain strokes, for example; Stimulation of the breasts or chest wall: the main example of stimulation is the sucking of the breasts by the baby, which activates the mammary glands and intensifies the production of cerebral prolactin and, consequently, the production of milk; Diseases that cause hormonal disorders: some of the main ones are hypothyroidism, cirrhosis of the liver, chronic renal failure, Addison's disease and polycystic ovary syndrome; Breast cancer: can cause galactorrhea in a single nipple, usually with blood; Use of medicines:
- Antipsychotics, such as Risperidone, Chlorpromazine, Haloperidol, or Metoclopramide; Opiates, such as Morphine, Tramadol, or Codeine; Gastric acid reducers, such as Ranitidine or Cimetidine; Antidepressants, such as Amitriptyline, Amoxapine, or Fluoxetine;; Use of hormones, such as estrogens, anti-androgens or HRT.
Sleep and stress are other conditions that cause an increase in prolactin production, however, they rarely cause enough changes to cause galactorrhea.
Common symptoms
Galactorrhea is the main symptom of hyperprolactinemia, or excess of prolactin in the body, and may be transparent, milky or bloody in color, and appear in one or both breasts.
However, other signs and symptoms may arise, since the increase in this hormone can cause changes in sex hormones, such as reduction of estrogen and testosterone, or, also, if there are tumors in the pituitary. The main symptoms are:
- Amenorrhea, which is the interruption of ovulation and menstruation in women; Sexual impotence and erectile dysfunction, in men; Infertility and decreased sexual desire; Osteoporosis; Headache; Visual changes such as turbidity and vision of bright spots.
Hormonal changes can also be responsible for infertility on the part of men or women.
How to diagnose
Galactorrhea is observed on medical clinical examination, which can be spontaneous or appear after nipple expression. Galactorrhea is confirmed whenever milk secretion occurs in men, or when it appears in women who are not pregnant or breastfeeding in the last 6 months.
To identify the cause of galactorrhea, the doctor will assess the history of medications and other symptoms that the person may experience. In addition, some tests can be done to investigate the cause of galactorrhea, such as the measurement of prolactin in the blood, measurement of TSH and T4 values, to investigate thyroid function, and, if necessary, brain MRI to investigate the presence of tumors or other changes in the pituitary gland.
How the treatment is done
The treatment for galactorrhea is guided by the endocrinologist, and varies according to the causes of the disease. When it is a side effect of some medication, you should talk to the doctor to evaluate the possibility of suspension or replacement of this by another.
When it is caused by some disease, it is important that it is treated properly, in order to stabilize hormonal disruptions, such as, for example, the replacement of thyroid hormones in hypothyroidism, or the use of corticosteroids for pituitary granulomas. Or, when galactorrhea is caused by a tumor, the doctor may recommend treatment with surgical removal or procedures such as radiotherapy.
In addition, there are drugs that can reduce the production of prolactin and control galactorrhea, while the definitive treatment is done, such as Cabergoline and Bromocriptine, which are drugs in the class of dopaminergic antagonists.
