Galactorrhea is milky discharge from the nipple that is not related to pregnancy or breastfeeding. It is often caused by high prolactin from a pituitary tumor (prolactinoma), medications or hypothyroidism.
Key symptoms
- Milky discharge from both nipples
- Missed or irregular periods and infertility
- Low libido or erectile dysfunction in men
- Headache or vision changes with a large pituitary tumor
What you find on exam
- Expressible milky discharge from several ducts
- Breast exam for masses
- Visual field testing for bitemporal hemianopia
- Signs of hypothyroidism: dry skin, slow reflexes
Tests
- Pregnancy test
- Prolactin, TSH and kidney function
- Medication review: antipsychotics such as risperidone, metoclopramide, opioids
- Pituitary MRI if prolactin is high without another cause
Treatment basics
- Stop or switch the causing drug if possible
- Treat hypothyroidism with levothyroxine
- Dopamine agonist such as cabergoline for prolactinoma
- Surgery for tumors that do not respond or press on the optic nerves
- Observation if mild with normal prolactin and periods
Red flags
- Bloody discharge from one duct or a breast mass
- Vision loss or severe headache
- Galactorrhea in a man
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.