Galactorrhea

Definition of galactorrhea

Galactorrhea indicates a serous or milky secretion from a nipple (or both), which occurs in women outside the lactation period ( non-puerperal galactorrhoea ). This anomalous milky secretion, typical of galactorrhea, appears very similar to colostrum (the "first milk" produced by the mammary glands in the immediate postpartum).

Incidence

The galactorrhea is physiological when the milk secretion continues, in the nursing mother, in the months following the birth: the mammary serous loss could occur following a nipple squeezing, but also spontaneously.

The milky secretions can be of different entity: some women complain of an abundant and copious production similar to milk, even some years after the birth, even though they do not present any pathology. For other women, however, the milky secretion from the nipple is modest and can be evoked by the mere pressing of the breast.

Considering that about 10% of breast cancers begin with nipple secretions, it is a good habit to go to the doctor from the first symptoms, except, obviously, for lactating women.

Even considering galactorrhea an exclusively female phenomenon, the disorder has also been found in some men (almost rare condition): in the male, the galactorrhea manifests itself not only with the milky secretion from the nipples, but is frequently accompanied by headache, decreased libido, possible impotence and blurred vision.

Related disorders

Galactorrhea can sometimes be confused with different types of breast secretions (purulent, blood leaks) that do not reflect endocrine modulations and deserve more thorough medical inspection.

Galactorrhea is often found in women with amenorrhea, hyperprolactinaemia, hypothyroidism, dyspareunia, infertility, oligomenorrhea, pituitary tumors and hyperandrogenism.

Classification

Based on the way in which the milky substance is secreted, galactorrhea can be defined as intermittent or continuous, spontaneous or induced (by squeezing the nipple), and bilateral or unilateral .

Moreover, it is appropriate to distinguish the galactorrhoea associated with amenorrhea from galactorrhea which occurs in women with regular menstruation: the etiological research and the consequent solution therapy are in fact different. From medical statistics, it emerges that 80% of women with galactorrhea also suffer from considerable menstrual delays ( amenorrhoea galactorrhoea syndrome ); when galactorrhea occurs together with amenorrhea, the woman is probably also affected by hyperprolactinemia and / or hypothyroidism.

In cases in which galactorrhea occurs without consistent menstrual irregularities, milky secretions from the nipples are generally due to the use of drugs (tricyclic antidepressants, opioids, birth control pills, neuroleptic drugs - eg phenothiazines, antihistamines, cimetidine, some antihypertensives), associated with stress conditions and alterations of prolactinemia values.

It is estimated that hyperprolactinemia occurs in 30% of women with galactorrhoea; in these cases, we speak of galactorrhea due to hyperprolactinemia, which may or may not be related to thyroid insufficiency. The increase in prolactin is a cause of galactorrhea, but it could also cause menstrual disorders and, in more serious cases, infertility. The galactorrhea is the first alarm bell for an alteration of the synthesis of prolactin, which can also occur independently of the change in hormone levels in the blood; otherwise, it has been estimated that only 16.5% of women with hyperprolactinaemia also suffer from galactorrhea (in other numbers and in other words, one in 6 women with hyperprolactinemia has abnormal milky secretions from the breast). [ Treaty of endocrinological functional diagnostics, D. Andreani, G. Menzinger, D. Andrean] .

The milky secretions typical of galactorrhea can be stopped by correcting the value of hormones altered in the blood.

In the aforementioned cases of galactorrhea induced by pharmacological / hormonal therapies, an increase in prolactimenia has occurred: this evidence shows how much prolactin values ​​can affect the manifestation of galactorrhoea.

Galactorrhoea amenorrhea syndrome

We have seen that galactorrhea is often related to amenorrhoea (amenorrhoea-galactorrhoea syndrome): in this regard, three sub-categories have been classified, corresponding, in turn, to other syndromes.

• In the syndrome of Forbes-Albright syndrome, the galactorrhoea-amenorrhea association is favored by a pituitary adenoma known as chromophobic adenoma;
• In Chiari-Frommel syndrome, galactorrhea and amenorrhea persist for many months after pregnancy;
• The Ahumada-del Castillo syndrome involves the connection between the two disorders (amenorrhea, galactorrhoea) regardless of pregnancy.

Diagnosis and therapies

Considering that the level of prolactin greatly affects the galactorrhea, it is understandable that the hormone dosage is of fundamental diagnostic importance; furthermore, it is advisable to carry out an investigation on the dosage of free thyroid hormones and on the thyroid-stimulating hormone (TSH).

The therapy of galactorrhea consists in the removal of the triggering factors, for which the hormonal balance is indispensable; however, even the administration of dopaminergic drugs could correct hyperprolactinemia, thus resolving galactorrhoea.

Summary

To fix the concepts ...