Makindo Medical Notes

🍼 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.