Galactorrhea: symptoms, causes, diagnosis and treatment

One of the main characteristics of humans as mammals is the development of the mammary glands, whose sole function is to provide food for the young; hence, at least in the human species, babies are also called infants.

However, a series of alterations in the production of the hormones responsible for the segregation of milk can cause a phenomenon known as galactorrhea, which usually occurs in women but can also occur occasionally in men.

• Related article: "Types of hormones and their functions in the human body"

Definition of galactorrhea

Galactorrhea refers to the secretion of milk through the mammary gland after the puerperal period has elapsed, that is, after six to eight weeks after delivery. In addition, this must remain for at least six months. Although, it is true that in certain women who have gone through several births this phenomenon can occur without these meaning that there is an underlying disease.

Galactorrhea cannot be considered a disease as such, but rather a sign that the person may be suffering from some other condition, usually producing secretion through both moms.

This phenomenon occurs particularly in women between 20 and 35 years of age with previous pregnancies. However, there are cases of galactorrhea present at other ages, in children and even in men.

As a general rule, between 20% and 25% of women with normal menstrual cycles and hormonal levels experience a phenomenon of galactorrhea at some point in their lives.

Galactorrhea symptoms

Although galactorrhea is considered a sign within a larger disorder, it may be accompanied by other associated symptoms. These symptoms can be very varied. in terms of type, frequency of appearance, etc., depending on the causes of the galactorrhea itself.

The most common signs of symptoms are:

• Variations during menstruation: irregular cycles or lack of menstrual cycle
• Sensitivity to temperature changes
• Increased thirst and the urge to urinate
• headaches
• Vision problems such as vague or blurred vision, double vision, or lack of vision
• erection problems, erectile dysfunction and lack of sexual desire in men
• Acne and the appearance of body hair

Causes

Outside of pathological circumstances, the manufacture of milk in the breasts is caused by several hormones and of them prolactin is the one with the most relevant role. This hormone is made in a gland called hypophysis, which is located at the base of the skull. In addition, the action of another hormone called placental lactogen is also involved.

The cause of the appearance of galactorrhea is due to an imbalance in the production of these two hormones. This alteration can have numerous causes, although the truth is that in half of the cases the cause remains undetermined. The most common reasons why this phenomenon appears are:

• Appearance of tumors in the pituitary.
• Side effect of the consumption of some drugs. These drugs usually belong to the groups of antipsychotics, antidepressants, antihypertensives, opioid drugs, antivomiting drugs, and anovulatory drugs.
• Endocrine conditions that alter hormone production, such as primary hypothyroidism.
• Excessive stimulation of the nipple.
• Physical and psychological stress.
• Chronic kidney disease.
• Hepatic cirrhosis.
• Local infections in the breast.
• Hypothalamic alterations that alter the correct regulation of the release of hormones.
• Chest injuries or surgeries.
• Other conditions such as polycystic ovaries, hyperthyroidism, spinal cord injuries, etc.

Diagnosis

The first step in the diagnosis of galactorrhea is to rule out that said secretion is not of another class other than milky. The reason is that any other type of discharge, with traces of blood, purulent or greenish tones, are a sign of other important diseases such as breast cancer, so it is vitally important to go to a health center as soon as it is detected the discharge.

The correct diagnosis of galactorrhea should include the preparation of a clinical history as detailed as possible, which include the patient's menstrual history, if she is female, to rule out the possibility that she is due to a pregnancy. In addition, to investigate sterility, impotence or variations in sexual appetite.

Also, it should be done a physical examination looking for signs of any other disease such as hypothyroidism and request a drug history to rule out this possible cause.

Next, a blood test is necessary to check the levels of thyroid hormones and prolactin in the blood. As the specialist clinician deems necessary, other tests can be carried out such as urinalysis or chest and abdomen x-rays.

If all of the above causes are excluded, it is most likely a prolactinoma. Prolactinoma is a benign tumor found in the pituitary gland., and although it is much more likely to occur in women, when it occurs in men it does so in a more pernicious way.

If galactorrhea occurs along with very high levels of prolactin in the blood, some type of sexual dysfunction, infertility or hypogonadism, it is logical to assume that it is a prolactinoma; so the specialist must perform a brain MRI to confirm the existence of a tumor.

Treatment

The intervention to be followed in the cases of patients presenting galactorrhea will depend on its causes. In the event that this occurs in isolation and without high levels of prolactin in the blood, the most common is that it disappears naturally, not requiring any type of treatment.

The exception would be the cases in which the secretion is a great discomfort, in which case the protocol mandates the administration of dopamine agonists, which increase the level of dopamine in the blood, a hormone that inhibits the formation of prolactin.

Likewise, when this phenomenon is associated with any other disease, the symptoms will subside when treating the main condition. In the event that the galactorrhea is produced by the effects of a drug, its suppression or a reduction in the dose should be enough for the symptoms to subside.

In people in whom magnetic resonance imaging does not detect the presence of a prolactinoma, it is necessary undergo periodic check-ups to rule out the appearance and growth of a tumor of the hypophysis.

Finally, in cases of prolactinoma, surgery is performed to remove the tumor,together with the administration of specific drugs and radiotherapy.