Galactorrhea

Etiology

• Pregnancy
• Structural
  • Prolactinoma more likely if prolactin levels over 100
  • Pituitary stalk compression
• Medications
  • Risperidone and other antipsychotics
  • Domperidone
  • Metoclopramide
  • Verapamil
• Macroprolactin

Pathophysiology

• Prolactin

Clinical Manifestations

• History
  • Menstrual history
  • Exercise
• Signs & Symptoms

Investigations

• Labs
  • Prolactin, which can be over 100 in pregnancy and prolactinoma
    • Normal is <25 in women and <20 in men

    500 is most likely adenoma

  • TSH, as TRH can stimulate prolactin to 30-50 range
  • Consider growth hormone
• Imaging
• Other

Management

• If prolactinoma
  • Cabergoline 0.25mg twice weekly
  • Alternative::Bromocryptine
  • Discontinue treatment once pregnant, unless macroadenoma
  • Monitor for return of menses and decrease in prolactin levels
  • Usually treat for 2 years, then can trial off medication if the lesion has resolved
  • Recheck post-partum after done lactation
  • Recheck post-meopausally
  • Rule out MEN1 if family history (i.e. r/o hyperparathyroid and pancreatic islet tumour)