Galactorrhea
Encyclopedia
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
."
s or local causes such as excessive nipple stimulation. Hormonal causes most frequently associated with galactorrhea are hyperprolactinemia and thyroid
conditions with elevated levels of TSH
or TRH hormones.
Lactation
requires the presence of estrogen
, progesterone
and prolactin
, and the evaluation of galactorrhoea includes eliciting a history for various medications or foods (methyldopa
, opiates, 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. Galactorrhoea may also be caused by hormonal imbalances owing to birth control pills.
Galactorrhoea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine
(trade name: Tagamet). Galactorrhoea can be also caused by anti-psychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Of these, risperidone
is the most notorious for causing this complication. Case reports suggest proton-pump inhibitors have been shown to cause Galactorrhoea.
secreted from the breast
s of many newborn infants. It is caused by a combination of the effects of maternal hormones before birth, prolactin and growth hormone passed through breast feeding and the postnatal pituitary and thyroid hormone surge in the infant. Witch's milk is more likely to be secreted by infants born at full term
, than by prematurely-born
infants. Breast milk production occurs in about 5% of newborns and can persist for two months though palpable breast buds can persist into childhood.
There is usually no treatment necessary; however, redness, tenderness, or fever may be a sign of mastitis
and may require antibiotics. Blood from the nipples is nearly always benign and associated with the normal growth of the ducts, rather than mastitis. Removing the milk from the breasts can prolong milk production and is considered necessary in some cultures. While breastfeeding may also contribute to prolonged milk production and breast enlargement, temporary or permanent weaning is not recommended.
In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirit
s.
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
from the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
, unassociated with childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
or nursing.
Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "nipple discharge
Nipple discharge
Nipple discharge is the release of fluid from the nipples of the breasts. Although it is considered normal in a wide variety of circumstances it is the third major reason involving the breasts for which women seek medical attention, after breast lumps and breast pain. It is also known to occur in...
."
Causes
It can be due to dysregulation of certain hormoneHormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s or local causes such as excessive nipple stimulation. Hormonal causes most frequently associated with galactorrhea are hyperprolactinemia and thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
conditions with elevated levels of TSH
Thyroid-stimulating hormone
Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...
or TRH hormones.
Lactation
Lactation
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process occurs in all female mammals, however it predates mammals. In humans the process of feeding milk is called breastfeeding or nursing...
requires the presence of estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
, progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
and prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...
, and the evaluation of galactorrhoea includes eliciting a history for various medications or foods (methyldopa
Methyldopa
Methyldopa is an alpha-adrenergic agonist psychoactive drug used as a sympatholytic or antihypertensive. Its use is now mostly deprecated following the introduction of alternative safer classes of agents...
, opiates, antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
s, as well as licorice) and for behavioral causes (stress, and breast and chest wall stimulation), as well as evaluation for pregnancy, pituitary adenoma
Pituitary adenoma
Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 15% of intracranial neoplasms. Tumors which exceed 10 mm in size are defined as macroadenomas, and those smaller than 10 mm are referred to as microadenomas...
s (with overproduction of prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...
or compression of the pituitary stalk), and hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
, which may be a diagnostic clue. Galactorrhoea may also be caused by hormonal imbalances owing to birth control pills.
Galactorrhoea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine
Cimetidine
Cimetidine INN is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach. It is largely used in the treatment of heartburn and peptic ulcers. It is marketed by GlaxoSmithKline under the trade name Tagamet...
(trade name: Tagamet). Galactorrhoea can be also caused by anti-psychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Of these, risperidone
Risperidone
Risperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...
is the most notorious for causing this complication. Case reports suggest proton-pump inhibitors have been shown to cause Galactorrhoea.
Neonatal Milk
Neonatal milk or witch's milk is milkMilk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
secreted from the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
s of many newborn infants. It is caused by a combination of the effects of maternal hormones before birth, prolactin and growth hormone passed through breast feeding and the postnatal pituitary and thyroid hormone surge in the infant. Witch's milk is more likely to be secreted by infants born at full term
Full Term
Full Term in the universities of Oxford and Cambridge refers to the eight weeks within the longer academic term during which lectures are given and students are required to be in residence...
, than by prematurely-born
Premature birth
In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...
infants. Breast milk production occurs in about 5% of newborns and can persist for two months though palpable breast buds can persist into childhood.
There is usually no treatment necessary; however, redness, tenderness, or fever may be a sign of mastitis
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...
and may require antibiotics. Blood from the nipples is nearly always benign and associated with the normal growth of the ducts, rather than mastitis. Removing the milk from the breasts can prolong milk production and is considered necessary in some cultures. While breastfeeding may also contribute to prolonged milk production and breast enlargement, temporary or permanent weaning is not recommended.
In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirit
Familiar spirit
In European folklore and folk-belief of the Medieval and Early Modern periods, familiar spirits were supernatural entities believed to assist witches and cunning folk in their practice of magic...
s.
External links
- familydoctor.org has a good overview of galactorrhea.
- http://www.calgaryhealthregion.ca/breasthealth/common_breast_conditions/gynecomastia_male.htm
- MR images Galactorrhea and Pituitary tumors (microadenoma)