Galactorrhoea:Report of Two Cases

Area of Science:

• Endocrinology
• Pharmacology
• Reproductive Medicine

Background:

• Galactorrhoea, the inappropriate discharge of milk, presents with diverse etiologies, ranging from physiological states like pregnancy and lactation to pathological conditions and drug-induced effects.
• Comprehensive evaluation typically involves detailed patient history, physical examination, laboratory investigations, and imaging studies to ascertain the underlying cause.

Purpose of the Study:

• To present two distinct and illustrative cases of galactorrhoea.
• To highlight that elevated serum prolactin levels are not invariably present in all galactorrhoea cases.
• To underscore the diagnostic utility of dynamic thyroid function tests in identifying galactorrhoea secondary to subclinical hypothyroidism.

Main Methods:

• Case report methodology detailing clinical presentation, diagnostic workup, and management.
• Review of patient histories focusing on medication use and endocrine status.
• Analysis of laboratory results, including serum prolactin and thyroid function tests.

Main Results:

• Case 1: Galactorrhoea attributed to a rare adverse drug reaction from concurrent domperidone and rabeprazole use.
• Case 2: Galactorrhoea associated with mild hypothyroidism, despite normal serum prolactin levels.
• Both cases demonstrated normal serum prolactin concentrations, challenging the common assumption of hyperprolactinemia in galactorrhoea.

Conclusions:

• Galactorrhoea can occur in the absence of elevated prolactin levels, necessitating a broader differential diagnosis.
• Mild hypothyroidism should be considered in the etiological workup of galactorrhoea, even in clinically euthyroid patients.
• Dynamic thyroid function testing can be instrumental in diagnosing occult thyroid dysfunction as a cause of galactorrhoea.