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Galactorrhoea
Related Subjects: | Adrenal Adenomas | Adrenal Cancer |Male Infertility |Sheehan's syndrome
Galactorrhoea = inappropriate, non-puerperal milk secretion. Most commonly due to hyperprolactinaemia, but always first exclude pregnancy and review the drug history.
📌 Causes
- 🧠 Prolactinoma (pituitary adenoma): Galactorrhoea, amenorrhoea, infertility, headaches, visual field loss.
- 🦋 Hypothyroidism: TRH stimulates prolactin ➝ galactorrhoea with fatigue, weight gain, cold intolerance.
- 💊 Medications: Antipsychotics, SSRIs, TCAs, methyldopa, verapamil.
- 🩸 Chronic kidney disease: Reduced clearance of prolactin ➝ galactorrhoea with CKD features (fatigue, oedema).
- ❓ Idiopathic: Diagnosis of exclusion; normal cycles, mild prolactin rise or normal.
🔎 Core Investigations
- ✅ Pregnancy test – always first.
- 💉 Serum prolactin – persistently elevated suggests prolactinoma or secondary cause.
- 🦋 Thyroid function tests – exclude hypothyroidism.
- 🩺 Renal function (U&E, eGFR) – exclude CKD.
- 🧠 MRI pituitary if prolactin persistently high.
- 👀 Visual fields if pituitary adenoma suspected.
💊 Management
- 🧠 Prolactinoma: Dopamine agonists (cabergoline, bromocriptine). Trans-sphenoidal surgery if resistant/large. Radiotherapy rarely.
- 🦋 Hypothyroidism: Levothyroxine replacement ➝ prolactin normalises.
- 💊 Drug-induced: Stop/switch offending drug if possible; dopamine agonists if severe symptoms and cannot stop.
- 🩸 CKD: Optimise CKD (dialysis, transplant). Dopamine agonists for symptomatic relief.
- ❓ Idiopathic: Observation if mild. Dopamine agonists if persistent/bothersome.
📝 OSCE / Exam Pearls
- Always say: “First exclude pregnancy.”
- Classic triad for prolactinoma = galactorrhoea + amenorrhoea + visual symptoms.
- Drug history is essential - antipsychotics and antidepressants are common culprits.
- Hypothyroidism causes galactorrhoea via ↑ TRH ➝ ↑ prolactin.
🎯 Key Takeaway
Galactorrhoea in adults is usually due to hyperprolactinaemia. Think: pregnancy → prolactin → thyroid → renal → pituitary MRI. Management is cause-specific, but dopamine agonists remain the cornerstone in prolactinoma. 🌟
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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