Galactorrhea

Galactorrhea is a condition in which milk or milk-like discharge is flown spontaneously from the breast, which is not associated with pregnancy, childbirth, or breastfeeding. Galactorrhea isn't a disease in itself. However, it could point towards an underlying problem that may or may not be serious. It is usually found in women, but it can affect men, adolescents, even children. It may result from excess production of a hormone called prolactin, side effects of some medicines, or excess breast stimulation. The cause for the illness should be thoroughly searched for, as sometimes it may be caused by pituitary gland tumors. The management focuses on identifying and treating the underlying cause. Often no cause of the galactorrhea can be established, known as idiopathic galactorrhea. Sometimes no treatment is needed, and it resolves by itself.

Galactorrhea is a consequence of the hormonal problem. Prolactin is a milk-producing hormone released by the pituitary gland located at the base of the brain, which is released in higher amounts near childbirth for producing milk for the baby. This hormone production is regulated by another hormone called dopamine. Any condition that can interfere with these hormones can result in galactorrhea. Some of such conditions are;

• Prolactinoma- a tumor secreting prolactin
• Thyroid hormone problem
• Disorders affecting the pituitary gland
• A bit much stimulation of the breasts during sexual activity, self-breast examination, or rubbing by clothes.
• Injuries to the chest wall, spinal cord, nerves, etc
• Medicines: birth control pills, antidepressants (SSRI), antipsychotics, opioids, etc

The following factors can increase your chances of having galactorrhea;

• Stress
• Performing a lot of self-breast examination
• Suffering from hypothyroidism
• Using antihypertensive medication such as verapamil, methyldopa, reserpine
• Using cocaine

Galactorrhea affects around 20 to 25 % of women. Hyperprolactinemia is the cause in about 75% of the patients having galactorrhea with amenorrhea, of which 30% are attributed to prolactin-secreting tumors. 

Signs and symptoms associated with galactorrhea are;

• Milky discharge - Continuous or on and off
• Involvement of one or both breasts
• Discharge may also be of yellow or green color
• Spontaneous flow or leak on touch
• Irregularities or absence of menstrual cycle
• Headaches
• Vision problems
• In males, it may be associated with testosterone deficiency and may be accompanied by enlargement or tenderness of breasts.
• Some newborns express milk from nipples, a condition called witch's milk, which is attributed to the maternal estrogens that might have transferred to the baby through the placenta. It is a temporary condition and resolves on its own. 

Your healthcare provider will take a detailed history of your symptoms, associated conditions, pregnancy, medication use. He would then perform a physical examination with a special focus on the breasts and signs of a tumor in the brain via a thorough neurological examination. Discharge from the breasts can be expressed and sent for laboratory analysis to confirm breast milk. To confirm the diagnosis, the following tests can be performed;

• Blood tests: These can show the levels of hormones; prolactin, thyroid hormones, estrogens, testosterone, etc. they can be used to check for overall health conditions and exclude other causes.
• Pregnancy test: it can be done on urine or blood to rule out pregnancy
• Mammography or ultrasound of the breasts: to rule out breast tumor
• Imaging tests: CT and MRI scans of the brain can enable doctors to look for a tumor in or near the pituitary gland 

Disorders related to galactorrhea include;

• Hypothyroidism
• Pituitary adenoma
• Bronchogenic carcinoma
• Molar pregnancy
• Breast surgery
• Acromegaly
• Cushing's disease
• Renal failure
• Burns
• Craniopharyngioma
• Lymphoma
• Sarcoid
• Pregnancy and postpartum

If you are having the symptoms of galactorrhea, be vigilant to consult your healthcare provider. They would try to find out the underlying cause to treat the condition and exclude a serious condition. Sometimes, no treatment is needed, and the condition resolves. When treatment is needed, it depends on the cause. Often treating the cause, treats galactorrhea. Stopping or changing medications that cause the condition will resolve galactorrhea as well. Similar is true for thyroid disorders. Treating them can stop galactorrhea also.

When a pituitary tumor causes galactorrhea, the treatment will depend on the nature and effects of the tumor. If it is benign, it may not need to be treated, or if it is large enough, some medicines are used to shrink its size. Rarely surgery is required.

When no underlying cause is determined, some medications can be used to control the production of prolactin. These include;

• Bromocriptine (Clycloset ,Parlodel )
• Cabergoline to lower prolactin level and minimize or stop the milky discharge.

Galactorrhea is not a life-threatening condition. If the causative factors are treated, it goes away on its own. However, it may be the cause of amenorrhea, infertility, and osteoporosis if left untreated and that requires medical attention.

There is not much you can do to prevent developing galactorrhea. However, some lifestyle modifications can help to reduce the risk.

• Don’t overdo it when it comes to breast examination.
• During sexual activity, avoid overstimulating the breasts
• Avoid wearing dresses with material that tends to irritate your nipples
• Manage stress with meditation or other methods

https://journals.lww.com/annalsplasticsurgery/Abstract/2022/04000/Galactorrhea_After_Nipple_Sparing_Mastectomy__Case.23.aspx