Galactorrhea (
also spelled galactorrhoea) (
galacto- +
-rrhea) or lactorrhea (
lacto- +
-rrhea) is the spontaneous flow of
milk from the
breast, unassociated with
childbirth or nursing.
Galactorrhea is reported to occur in 5–32% of women. Much of the difference in reported incidence can be attributed to different definitions of galactorrhea.
Although frequently benign, it may be caused by serious underlying conditions and should be properly investigated. Galactorrhea also occurs in males, newborn infants and adolescents of both sexes.
Causes
Galactorrhea can take place as a result of dysregulation of certain
hormones. Hormonal causes most frequently associated with galactorrhea are
hyperprolactinemia and
thyroid conditions with elevated levels of
thyroid-stimulating hormone (TSH) or
thyrotropin-releasing hormone (TRH). No obvious cause is found in about 50% of cases.
[
Lactation requires the presence of prolactin, and the evaluation of galactorrhea includes eliciting a history for various medications or foods ( methyldopa, opioids, antipsychotics, serotonin reuptake inhibitors) and for behavioral causes (stress, breast, and chest wall stimulation), as well as evaluation for gestation, pituitary adenomas (with overproduction of prolactin or compression of the pituitary stalk), and ]hypothyroidism
Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as po ...
. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and infertility
Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal state ...
, 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
Cimetidine, sold under the brand name Tagamet among others, is a histamine H2 receptor antagonist that inhibits stomach acid production. It is mainly used in the treatment of heartburn and peptic ulcers.
The development of longer-acting H2 rec ...
(Tagamet). Galactorrhea can also be caused by antipsychotics 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 galactorrhea.
Neonatal milk
Neonatal milk or witch's milk is milk secreted from the breasts of approximately 5% of newborn infants. It is considered a normal variation and no treatment or testing is necessary. In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirits.
See also
* Lactation failure
* Galactagogue
* Mammoplasia
* Hypothalamic–pituitary–prolactin axis
References
External links
{{Pathology of pregnancy, childbirth and the puerperium
Breast milk
Infancy
European witchcraft
Breast diseases