Causes of Galactorrhoea
🍼 Galactorrhoea
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. 🌟
