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Galactorrhea, also called hyperlactation, is the production of milk or a milk-like secretion from the breasts. It mostly affects women although it may occur in men and sometimes even babies. Breastmilk is usually produced in the breasts of women after childbirth, however, in galactorrhea milk production and secretion arises even without pregnancy or breastfeeding. It must be differentiated from any other breast discharge like pus which is due to an infection of the breast (mastitis).
What causes breastmilk in men or women without pregnancy?
Causes of Galactorrhea
Galactorrhea has a myriad of causes. The most common cause of galactorrhea in both men and women is a tumor of the pituitary gland, a small pea-shaped gland situated just below the brain that produces a hormone called prolactin. It stimulates the breast tissues to produce breast milk after child birth. Tumors in the pituitary gland can lead to an unusual production of prolactin and therefore cause a milk-like discharge from the nipples. These tumors may be less than 10 mm (microadenomas) or more than 10 mm in size (macroadenomas).
Galactorrhea can be caused by underactivity of the thyroid gland (hypothyroidism). This leads to a lower than normal levels of thyroid hormones which in turn stimulates the pituitary to produce and secrete excessive amounts of prolactin and another pituitary hormone called thyroid stimulating hormone (TSH).
A common modifiable cause of galactorrhea is the intake of certain drugs like those used for the control of blood pressure (methyldopa), birth control pills, some opioid painkillers (morphine), and drugs used in depression (phenothiazines). Some herbal supplements like fennel and fenugreek can also cause galactorrhea.
Other causative factors of galactorrhea are excessive physical stimulation of the breasts associated with sexual activity and frequent self-examinations, or persistent friction due to tight clothing. Spinal cord injury or tumors, chronic kidney diseases, and other pituitary disorders can also cause galactorrhea. Sometimes the cause may not be evident in which case it is termed idiopathic galactorrhea. Oversensitivity of the breast tissue to prolactin can cause galactorrhea with even normal levels of prolactin in the body.
Men and Babies
In men, galactorrhea occurs due to hypogonadism, a condition caused by deficiency of the male sex hormone testosterone. This leads to enlargement of the breasts and a loss of sexual drive. In babies under the age of one year, galactorrhea can be caused by excess levels of estrogen which passes from the mother to the baby while still in he womb. Estrogen leads to enlargement of the breast tissues and secretion of milk (neonatal milk) which is also sometimes called witch’s milk.
What are the symptoms of galactorrhea?
Signs and Symptoms
A milk-like or grayish discharge from one or both nipples is the main symptom in galactorrhea. The discharge usually has no blood. Women with galactorrhea may have other complaints like dryness vagina, loss of libido, or pain during intercourse. There may be infrequent or irregular menstrual cycles, or no menstruation at all (amenorrhea). These are essentially due to low levels of estrogen. Infertility in both men and women can be a consequence of galactorrhea.
In others, the pituitary tumor can press upon the adjacent structures in the brain to cause various symptoms. It can press upon the nerves of the eyes and lead to partial or complete loss of vision. Increased pressure due to the space-occupying lesion may lead to headaches. Men may have breasts that are larger than usual with a milky secretion from one or both breasts, loss of sexual desire and erectile dysfunction, and other symptoms like loss of vision and headaches.
How is galactorrhea diagnosed?
Diagnosis
The presenting symptoms may be highly suggestive of galactorrhea and breast examination may confirm the milky discharge. In women of child bearing age, it is important to do a pregnancy test to rule out pregnancy as a possible cause. The investigations include a blood test to measure the levels of prolactin. A computed tomography (CT) scan of or magnetic resonance imaging (MRI) may be required to confirm the presence of tumors and determine the exact location. If the tumor is large, a further evaluation by an eye surgeon (ophthalmologist) will help to determine the possible effects on vision. A mammography or an ultrasound may be needed to examine the breast tissue if there is a suspicion of some lump or problem in the breast. The discharge from nipples may be examined under the microscope to look for any traces of blood or white blood cells.
How is galactorrhea treated?
Treatment
The treatment depends upon the underlying cause. The intake of any possible drugs causing galactorrhea should be discontinued. No treatment may be prescribed if the prolactin levels are not very high and the CT or MRI shows either a very small tumor or none at all.
The other underlying medical conditions like hypothyroidism, or tumors should be treated. The medical treatment of galactorrhea includes the use of bromocriptine and cabergoline. These drugs stimulate the production of another chemical messenger called dopamine that blocks prolactin production. These may result in shrinkage in the size of the tumor, improvement in vision, restoration of menstruation, and normalization of levels of prolactin and sex hormones. These can be used even after surgery to help any residual tumors. Recurrence of symptoms once the drugs are stopped is common. Since levels of estrogen may be low, women who are not planning to fall pregnant can be given birth control pills that contain estrogen.Regular monitoring with a CT or MRI should be repeated every year for at least 2 years to ensure that the tumor does not grow further.
Surgery may be done either for small tumors or when the mass effects of the growing tumors lead to headaches and vision loss. Radiation therapy is sometimes used when drugs and surgery are do not achieve the desired results. Galactorrhea can be a subtle sign of an atrocious disorder. Early diagnosis and treatment are important.
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