GALACTORRHOEA

GALACTORRHOEA

Galactorrhea: Excessive Milk Secretion Unrelated to Lactation

Definition

Galactorrhea is a condition characterized by the spontaneous flow of milk from the breast, unrelated to lactation.

Types

• Pathological Galactorrhea: This type is associated with hormonal imbalances, particularly hyperprolactinemia.
• Physiological Galactorrhea: This type is not associated with hormonal imbalances and is often seen in newborns.

Causes

• Hormonal Causes:
  • Hyperprolactinemia
  • Hypothyroidism
  • Polycystic ovary syndrome (PCOS)
  • Pregnancy
  • Pituitary tumors
• Systemic Causes:
  • Liver disease
  • Kidney disease
  • Hypocalcemia
  • Hypokalemia
• Drug-induced Causes:
  • Opiates
  • Antipsychotics
  • Antiemetics
  • Dopamine antagonists
  • Estrogens
  • Oral contraceptives
  • Thyroid medications

Clinical Features

• Spontaneous flow of milk from the breast
• May be unilateral or bilateral
• Can occur at any age
• Often associated with hormonal imbalances

Investigations

• Blood tests to check for hormonal imbalances (hyperprolactinemia)
• Imaging studies (MRI) to rule out pituitary tumors
• Liver and kidney function tests

Complications

• Social embarrassment
• Discomfort
• Infection

Management

• Treatment of underlying hormonal imbalances (hyperprolactinemia)
• Management of systemic causes (liver disease, kidney disease)
• Discontinuation of causative medications
• Supportive measures (breast binding, medications to dry up milk)

Treatment

• Medical Treatment:
  • Dopamine agonists (bromocriptine, cabergoline)
  • Anti-hormonal medications (estrogen receptor modulators)
  • Selective estrogen receptor modulators (SERMs)
  • Gonadotropin-releasing hormone (GnRH) agonists
• Surgical Treatment:
  • Hormonal Ablation: → Step 1: Administer dopamine agonists to reduce prolactin levels → Step 2: Monitor prolactin levels and adjust medication as needed → Step 3: Consider surgical intervention if medical treatment is ineffective
  • Surgical Interventions: → Step 1: Pituitary tumor resection (transsphenoidal surgery) → Step 2: Adrenalectomy (for hormone-sensitive tumors) → Step 3: Radiotherapy (for hormone-resistant tumors)

Homoeopathic Therapeutic Medicines

• Pulsatilla: For galactorrhea associated with hormonal imbalances
• Calcarea: For galactorrhea associated with hypocalcemia
• Nux vomica: For galactorrhea associated with opiate use
• Lycopodium: For galactorrhea associated with liver disease