Galactorrhoea + Nipple Discharge Flashcards
(15 cards)
What is galactorrhoea?
- Breast milk production non assocaited with pregnancy or breast feeding
- Bilateral multi-ductal milky white nipple discharge
What hormone is responsible for breast milk production?
Prolactin
What prevents breast milk production in pregnancy?
Oestrogen + progesterone inhibit prolactin secretion
What hormone is responsible for breast milk excretion
Oxytocin
Causes of hyperprolactinaemia
- idiopathic
- prolactinomas
- hypothyroidism
- PCOS
- anti psychotic meds/dopamine antagonists
Presentation of hyperprolactinaemia
- galactorrhoea
- ED
- gynaecomastia
- reduced libido
- amenorrhoea
- fertility problems
Types of prolactinomas
- microprolactinomas: <10mm
- macroprolactinomas: >10mm
Adverse effects of macroprolactinomas
Bitemporal hemianopia
Headaches
Investigations of galactorrhoea
- pregnancy test
- blood tests: serum prolactin, U&Es, LFTs, TFTs
- MRI head with contrast for pituitary tumours
What is the investigation of choice for pituitary tumours?
MRI head with IV contrast
Management of galactorrhoea
- treat underlying cause
- dopamine agonists e.g. cabergoline
- trans-sphenoidal removal of pituitary tumour
Definitive treatment of pituitary adenoma causes hyperprolactinaemia
Trans-sphenoidal removal of pituitary tumour
What can cause nipple discharge?
- breast feeding/pregnancy
- galactorrhoea
- mammary duct ectasia
- pus from abscess
- intraductal papilloma
- fibrocystic changes
What colour nipple discharge can mammary duct ectasia cause?
Whiter
Grey
Green
What colour nipple discharge can intraductal papilloma cause?
Clear or blood stained
