galattorrea

Galattorrea, or galactorrhea in English, is the discharge of milk from the nipples that occurs outside the context of pregnancy or breastfeeding. It may be bilateral or unilateral, and discharge can be spontaneous or triggered by nipple stimulation. In most cases the discharge is nonbloody and can vary in amount and duration. Galattorrea is a symptom rather than a disease and requires evaluation to identify an underlying cause.

Common causes fall into physiologic and pathologic categories. Physiologic causes include pregnancy and lactation, hormonal changes around puberty, or nipple stimulation. Pathologic causes are more diverse and often relate to elevated prolactin levels (hyperprolactinemia). The most frequent pathologic causes are prolactin-secreting pituitary tumors (prolactinomas) and medications that raise prolactin, such as certain antipsychotics, antiemetics, and some antidepressants. Other contributors can include hypothyroidism, chest wall irritation or injury, kidney or liver disease, and less commonly pituitary stalk compression or endocrine disorders.

Diagnostic approach typically begins with a detailed history and physical examination, including pregnancy testing and breast examination. If hyperprolactinemia is suspected, serum prolactin is measured, and additional tests may include thyroid function and kidney/hepatic function. When prolactin levels are elevated or symptoms persist, brain imaging with MRI is often performed to assess the pituitary gland. In some cases, tests for macroprolactin or further hormonal assays are used to refine the diagnosis.

Treatment targets the underlying cause. If a medication is responsible, switching to an alternative can resolve symptoms. Hyperprolactinemia due to a prolactinoma is commonly treated with dopamine agonists such as cabergoline or bromocriptine, which can reduce prolactin levels and shrink tumors. Thyroid replacement is used for hypothyroidism, and other conditions are managed accordingly. Most cases are treatable, and symptoms often improve with appropriate intervention. See also prolactin, prolactinoma, hyperprolactinemia.