Galactorrhea: Difference between revisions

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

VisualWikitext

Revision as of 19:48, 10 November 2016

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

3

Differentiating Galactorrhea from other Diseases

In alphabetical order. ^[2] ^[3]

Drugs- Estropipate, Haloperidol,Iloperidone, Trifluoperazine
Fibrocystic Disease
Hyperprolactinemia
Idiopathic (with menses)
Inflammation
Intraductal papilloma
Malignant neoplasm
Oral contraceptives
Recently preceded pregnancy
Trauma

References

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

Template:Diseases of the pelvis, genitals and breasts

Template:WH Template:WS

[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

[1]

[2]

[3]

v t e Pathology of pregnancy, childbirth and the puerperium (O, 630-676)
Pregnancy with abortive outcome	Ectopic pregnancy - Hydatidiform mole - Miscarriage
Oedema, proteinuria and hypertensive disorders	Pregnancy-induced hypertension - Pre-eclampsia - Eclampsia - Gestational diabetes
Other, predominantly related to pregnancy	Hyperemesis gravidarum - Gestational pemphigoid - Intrahepatic cholestasis of pregnancy
Maternal care related to the fetus and amniotic cavity and possible delivery problems	Polyhydramnios - Oligohydramnios - Chorioamnionitis - Premature rupture of membranes - Amniotic band syndrome - Placenta praevia - Braxton Hicks contractions - Antepartum haemorrhage - Placental abruption
Complications of labour and delivery	Premature birth - Postmature birth - Cephalopelvic disproportion - Dystocia (Shoulder dystocia) - Fetal distress - Vasa praevia - Uterine rupture - hemorrhage - Placenta accreta - Umbilical cord prolapse - Amniotic fluid embolism
Maternal complications in the weeks after childbirth	Puerperal fever - Peripartum cardiomyopathy - Postpartum thyroiditis - Galactorrhea - Postpartum depression
Complications related to the fetus	Fetal intervention - Fetal surgery
Other	Maternal death

@@ Line 22: / Line 22: @@
 ==Causes==
-It can be due to dysregulation of certain [[hormone]]s or local causes such as excessive nipple stimulation.
+===Common Causes===
+*[[Ahumada-del castillo syndrome]]
+*[[Domperidone]]
+*[[Fluoxetine]]
+*[[Hypothyroidism]]
+*[[Meningoencephalitis]]
+*[[Methyldopa]]
+*[[Metoclopramide]]
+*[[Prolactinomas]]
+*[[Verapamil]]
-Lactation requires the presence of [[estrogen]], [[progesterone]] and [[prolactin]], and the evaluation of galactorrhea includes eliciting a history for various medications or foods ( [[Loxapine]], [[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. Galactorrhea is also a side effect associated with the use of the second-generation [[H2 receptor antagonist]], [[Cimetidine]] (trade name: Tagamet) and dopamine antagonist such as [[Metoclopramide]].
+===Causes by Organ System===
+{|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
+|-
+|}
+===Causes in Alphabetical Order===
+{{columns-list|3|
+*[[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]]
+}}
 == Differentiating Galactorrhea from other Diseases ==

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