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galactorrhea
Expression of milk from the nipples of the breast or continued lactation after cessation of nursing. May be normal. May occur during puberty or pregnancy & may continue for months or years after cessation of lactation.
Etiology:
1) pharmacologic causes:
a) methyldopa
b) phenothiazines
c) tricyclic antidepressants
2) hyperthyroidism or hypothyroidism
3) pituitary adenoma (prolactin-secreting)
Clinical manifestations:
1) headaches, visual field disturbances or other neurologic symptoms suggest pituitary adenoma
2) palpitations, weight change, or changes in skin or hair suggest thyroid disorder
3) bilateral milky discharge from nipples
Laboratory:
1) pregnancy test
2) serum prolactin
3) thyroid function tests
Radiology:
- magnetic resonance imaging (MRI) of sella turcica if serum prolactin is significantly elevated
Management:
1) observation if serum prolactin & thyroid function tests are normal
2) bromocriptine for persistent galactorrhea not secondary to pituitary adenoma
3) referral to an endocrinologist
General
sign/symptom
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 830
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 384.