Galactorrhea: Difference between revisions

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==Overview==
==Overview==


'''Galactorrhea''' or '''galactorrhoea''' is the spontaneous flow of [[milk]] from the [[breast]], unassociated with [[childbirth]] or nursing.  
'''Galactorrhea''' or '''galactorrhoea''' is the spontaneous flow of [[milk]] from the [[breast]], unassociated with [[childbirth]] or nursing. Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "[[nipple discharge]]." <ref>Ladewig, P., London, M., Davidson, M. (2006). ''Contemporary Maternal-Newborn Nursing Care'' (6th ed.). New Jersey: Pearson Education, Inc. ISBN 0131703927.</ref>


Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "[[nipple discharge]]." <ref>Ladewig, P., London, M., Davidson, M. (2006). ''Contemporary Maternal-Newborn Nursing Care'' (6th ed.). New Jersey: Pearson Education, Inc. ISBN 0131703927.</ref>
==Causes==
===Common Causes===
*[[Ahumada-del castillo syndrome]]
*[[Domperidone]]
*[[Fluoxetine]]
*[[Hypothyroidism]]
*[[Meningoencephalitis]]
*[[Methyldopa]]
*[[Metoclopramide]]
*[[Prolactinomas]]
*[[Verapamil]]


==Common Causes==
===Causes by Organ System===
It can be due to dysregulation of certain [[hormone]]s or local causes such as excessive nipple stimulation.
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Idiopathic intracranial hypertension]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Licorice]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Shingles]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alimemazine]],  [[Amisulpride]],  [[Amoxapine]],  [[Antihypertensive medication]],  [[Antipsychotics]],  [[Birth control ]],  [[Chlorpromazine]],  [[Cimetidine]],  [[Deserpidine]],  [[Domperidone]],  [[Dutetrabenazine]],  [[Ethinylestradiol]],  [[Fluoxetine]],  [[Flupentixol]],  [[Haloperidol]],  [[Levomepromazine]],  [[Loxapine ]],  [[Methyldopa]],  [[Methyldopate]],  [[Metoclopramide]],  [[Olanzapine]],  [[Oral contraceptives]],  [[Paliperidone]],  [[Paroxetine ]],  [[Perazine]],  [[Phenothiazines]],  [[Pimozide]],  [[Pipothiazine]],  [[Reserpine]],  [[Risperidone]],  [[Tetrabenazine]],  [[Trifluperidol]],  [[Verapamil]],  [[Zotepine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Anterior pituitary hyperhormonotrophic syndrome ]],  [[Cushing disease]],  [[Excessive prolactin ]],  [[Forbes-albright syndrome ]],  [[Hyperoestrogenic states]],  [[Hypothyroidism]],  [[Multiple endocrine neoplasia type 1]],  [[Pineal tumour]],  [[Pituitary adenomas]],  [[Pituitary cancer ]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Shingles]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Craniopharyngiomas]],  [[Intracranial space-occupying lesion]],  [[Meningoencephalitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Insulin receptor defect with insulin-resistant diabetes mellitus]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Ahumada-del castillo syndrome ]],  [[Breast feeding]],  [[Breast stimulation]],  [[Chest wall stimulation]],  [[Chiari-frommel syndrome ]],  [[Excessive prolactin ]],  [[Metastatic breast carcinoma]],  [[Nipple stimulation]],  [[Pregnancy]],  [[Prolactin overproduction]],  [[Prolactinomas]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Craniopharyngiomas]],  [[Forbes-albright syndrome ]],  [[Metastatic breast carcinoma]],  [[Multiple endocrine neoplasia type 1]],  [[Neoplasm]],  [[Pineal tumour]],  [[Pituitary adenomas]],  [[Pituitary cancer ]],  [[Prolactinomas]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Opiates]],  [[Opioids]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Stress]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Sarcoidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Sarcoidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Nipple stimulation]],  [[Sexual intercourse]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Head trauma]],  [[Physical exertion]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}


Lactation requires the presence of [[estrogen]], [[progesterone]] and [[prolactin]], and the evaluation of galactorrhea includes eliciting a history for various medications or foods ([[methyldopa]], [[opiates]], some typical [[antipsychotic]]s, as well as [[licorice]]) and for behavioral causes (stress, and breast and chest wall stimulation), as well as evaluation for pregnancy, [[pituitary adenoma]]s (with overproduction of [[prolactin]] or compression of the pituitary stalk), and [[hypothyroidism]]. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and [[infertility]], which may be a diagnostic clue. Galactorrhea may also be caused by hormonal imbalances owing to birth control pills.
===Causes in Alphabetical Order===
{{columns-list|
*[[Ahumada-del castillo syndrome ]]
*[[Alimemazine]]
*[[Amisulpride]]
*[[Amoxapine]]
*[[Anterior pituitary hyperhormonotrophic syndrome ]]
*[[Antihypertensive medication]]
*[[Antipsychotics]]
*[[Birth control ]]
*[[Breast feeding]]
*[[Breast stimulation]]
*[[Chest wall stimulation]]
*[[Chiari-frommel syndrome ]]
*[[Chlorpromazine]]
*[[Cimetidine]]
*[[Craniopharyngiomas]]
*[[Cushing disease]]
*[[Deserpidine]]
*[[Domperidone]]
*[[Dutetrabenazine]]
*[[Ethinylestradiol]]
*[[Excessive prolactin ]]
*[[Fluoxetine]]
*[[Flupentixol]]
*[[Forbes-albright syndrome ]]
*[[Haloperidol]]
*[[Head trauma]]
*[[Hyperoestrogenic states]]
*[[Hypothyroidism]]
*[[Idiopathic intracranial hypertension]]
*[[Insulin receptor defect with insulin-resistant diabetes mellitus]]
*[[Intracranial space-occupying lesion]]
*[[Levomepromazine]]
*[[Licorice]]
*[[Loxapine ]]
*[[Meningoencephalitis]]
*[[Metastatic breast carcinoma]]
*[[Methyldopa]]
*[[Methyldopate]]
*[[Metoclopramide]]
*[[Multiple endocrine neoplasia type 1]]
*[[Neoplasm]]
*[[Nipple stimulation]]
*[[Olanzapine]]
*[[Opiates]]
*[[Opioids]]
*[[Oral contraceptives]]
*[[Paliperidone]]
*[[Paroxetine ]]
*[[Perazine]]
*[[Phenothiazines]]
*[[Physical exertion]]
*[[Pimozide]]
*[[Pineal tumour]]
*[[Pipothiazine]]
*[[Pituitary adenomas]]
*[[Pituitary cancer ]]
*[[Pregnancy]]
*[[Prolactin overproduction]]
*[[Prolactinomas]]
*[[Reserpine]]
*[[Risperidone]]
*[[Sarcoidosis]]
*[[Sexual intercourse]]
*[[Shingles]]
*[[Stress]]
*[[Tetrabenazine]]
*[[Trifluperidol]]
*[[Verapamil]]
*[[Zotepine]]
}}


Galactorrhea is also a side effect associated with the use of the second-generation [[H2 receptor antagonist]] [[Cimetidine]] (trade name: Tagamet).
== Differentiating Galactorrhea from other Diseases ==
 
== Differential Diagnosis ==


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


* [[Drugs]]
* [[Drugs]]- [[Estropipate]], [[Haloperidol]],[[Iloperidone]], [[Trifluoperazine]]
* [[Fibrocystic Disease]]
* [[Fibrocystic Disease]]
* [[Prolactin|Hyperprolactinemia]]
* [[Prolactin|Hyperprolactinemia]]
Line 53: Line 243:


[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Medical signs]]
[[Category:Symptoms]]
[[Category:Symptoms]]
[[Category:Milk]]
[[Category:Milk]]

Latest revision as of 21:01, 10 January 2020

Galactorrhea
ICD-10 N64.3, O92.6
ICD-9 611.6, 676.6
DiseasesDB 6314
MeSH D005687

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Galactorrhoea-Hyperprolactinaemia; hyperlactation; hyperprolactinaemia; lactation, increased; galactorrhea-hyperprolactinemia

Overview

Galactorrhea or galactorrhoea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "nipple discharge." [1]

Causes

Common Causes

Causes by Organ System

Cardiovascular Idiopathic intracranial hypertension
Chemical/Poisoning Licorice
Dental No underlying causes
Dermatologic Shingles
Drug Side Effect Alimemazine, Amisulpride, Amoxapine, Antihypertensive medication, Antipsychotics, Birth control , Chlorpromazine, Cimetidine, Deserpidine, Domperidone, Dutetrabenazine, Ethinylestradiol, Fluoxetine, Flupentixol, Haloperidol, Levomepromazine, Loxapine , Methyldopa, Methyldopate, Metoclopramide, Olanzapine, Oral contraceptives, Paliperidone, Paroxetine , Perazine, Phenothiazines, Pimozide, Pipothiazine, Reserpine, Risperidone, Tetrabenazine, Trifluperidol, Verapamil, Zotepine
Ear Nose Throat No underlying causes
Endocrine Anterior pituitary hyperhormonotrophic syndrome , Cushing disease, Excessive prolactin , Forbes-albright syndrome , Hyperoestrogenic states, Hypothyroidism, Multiple endocrine neoplasia type 1, Pineal tumour, Pituitary adenomas, Pituitary cancer 
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Shingles
Musculoskeletal/Orthopedic No underlying causes
Neurologic Craniopharyngiomas, Intracranial space-occupying lesion, Meningoencephalitis
Nutritional/Metabolic Insulin receptor defect with insulin-resistant diabetes mellitus
Obstetric/Gynecologic Ahumada-del castillo syndrome , Breast feeding, Breast stimulation, Chest wall stimulation, Chiari-frommel syndrome , Excessive prolactin , Metastatic breast carcinoma, Nipple stimulation, Pregnancy, Prolactin overproduction, Prolactinomas
Oncologic Craniopharyngiomas, Forbes-albright syndrome , Metastatic breast carcinoma, Multiple endocrine neoplasia type 1, Neoplasm, Pineal tumour, Pituitary adenomas, Pituitary cancer , Prolactinomas
Ophthalmologic No underlying causes
Overdose/Toxicity Opiates, Opioids
Psychiatric Stress
Pulmonary Sarcoidosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Sarcoidosis
Sexual Nipple stimulation, Sexual intercourse
Trauma Head trauma, Physical exertion
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Differentiating Galactorrhea from other Diseases

In alphabetical order. [2] [3]

References

  1. ↑ Ladewig, P., London, M., Davidson, M. (2006). Contemporary Maternal-Newborn Nursing Care (6th ed.). New Jersey: Pearson Education, Inc. ISBN 0131703927.
  2. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  3. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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