Content
Galactorrhea is the inappropriate secretion of a liquid containing milk from the breast, which appears in men or women who are not pregnant or breastfeeding. It is usually a symptom caused by increased prolactin, a hormone produced in the brain whose function is to induce the formation of milk by the breasts, a condition called hyperprolactinemia.
The main causes for the increase in prolactin are pregnancy and breastfeeding, and there are several causes for its inappropriate increase, including brain pituitary tumor, use of medications, such as some neuroleptics and antidepressants, breast stimulation or some endocrine diseases, such as hypothyroidism and polycystic ovary syndrome.
Thus, to treat hyperprolactinemia and galactorrhea, it is necessary to resolve its cause, either by removing a medication or treating a disease that is inducing the production of milk by the breasts.
Main causes
The main causes for breast milk production are pregnancy and breastfeeding, however, galactorrhea happens, mainly due to situations such as:
- Pituitary adenoma: it is a benign tumor of the pituitary gland, responsible for the production of several hormones, including prolactin. The main type is prolactinoma, which usually causes an increase in blood prolactin levels greater than 200mcg / L;
- Other changes in the pituitary gland: cancer, cyst, inflammation, irradiation or strokes of the brain, for example;
- Stimulation of the breasts or chest wall: the main example of stimulation is the sucking of the breasts by the baby, which activates the mammary glands and intensifies the production of cerebral prolactin and, consequently, the production of milk;
- Diseases that cause hormonal disorders: some of the main ones are hypothyroidism, cirrhosis of the liver, chronic renal failure, Addison's disease and polycystic ovary syndrome;
- Breast cancer: can cause galactorrhea in a single nipple, usually with blood;
- Use of medicines:
- Antipsychotics, such as Risperidone, Chlorpromazine, Haloperidol or Metoclopramide;
- Opiates, such as Morphine, Tramadol or Codeine;
- Gastric acid reducers, such as Ranitidine or Cimetidine;
- Antidepressants, such as Amitriptyline, Amoxapine or Fluoxetine;
- Some antihypertensive drugs, such as Verapamil, Reserpina and Metildopa;
- Use of hormones, such as estrogens, anti-androgens or HRT.
Sleep and stress are other conditions that cause increased production of prolactin, however, they rarely cause enough changes to cause galactorrhea.
Common symptoms
Galactorrhea is the main symptom of hyperprolactinemia, or excess of prolactin in the body, and may be transparent, milky or bloody in color, and appear in one or both breasts.
However, other signs and symptoms may arise, since the increase in this hormone can cause changes in sex hormones, such as reduction of estrogen and testosterone, or, also, if there are tumors in the pituitary. The main symptoms are:
- Amenorrhea, which is the interruption of ovulation and menstruation in women;
- Sexual impotence and erectile dysfunction in men;
- Infertility and decreased sexual desire;
- Osteoporosis;
- Headache;
- Visual changes, such as turbidity and vision of bright spots.
Hormonal changes can also be responsible for infertility on the part of men or women.
How to diagnose
Galactorrhea is observed on clinical medical examination, which can be spontaneous or appear after nipple expression. Galactorrhea is confirmed whenever milk secretion occurs in men, or when it appears in women who are not pregnant or breastfeeding in the last 6 months.
To identify the cause of galactorrhea, the doctor will assess the history of medications and other symptoms that the person may experience. In addition, some tests can be done to investigate the cause of galactorrhea, such as the measurement of prolactin in the blood, measurement of TSH and T4 values, to investigate thyroid function, and, if necessary, brain magnetic resonance to investigate the presence of tumors or other changes in the pituitary gland.
How the treatment is done
The treatment for galactorrhea is guided by the endocrinologist, and varies according to the causes of the disease. When it is a side effect of a medication, you should talk to the doctor to assess the possibility of suspension or replacement of this medication with another one.
When it is caused by some disease, it is important that it is treated properly, in order to stabilize hormonal disruptions, such as, for example, the replacement of thyroid hormones in hypothyroidism, or the use of corticosteroids for pituitary granulomas. Or, when galactorrhea is caused by a tumor, the doctor may recommend treatment with surgical removal or procedures such as radiotherapy.
In addition, there are drugs that can reduce prolactin production and control galactorrhea, while definitive treatment is given, such as Cabergoline and Bromocriptine, which are drugs in the class of dopaminergic antagonists.
Created by: Tua Saúde Editorial Team