Galactorrhea: Rapid Evidence Review.

Area of Science:

• Endocrinology
• Reproductive Health

Background:

• Galactorrhea is defined as the production of breast milk outside of physiologic lactation.
• While discharge within a year of pregnancy cessation is typically normal, persistent galactorrhea often indicates underlying medical conditions.

Purpose of the Study:

• To outline the diagnostic approach and management strategies for galactorrhea.
• To identify common and less common causes of hyperprolactinemia leading to galactorrhea.

Main Methods:

• Initial assessment includes a pregnancy test for premenopausal women.
• Laboratory evaluation involves prolactin, thyroid-stimulating hormone, and renal function tests.
• Further investigation with pituitary MRI may be indicated for unclear hyperprolactinemia causes.

Main Results:

• Hyperprolactinemia, frequently due to medications or pituitary microadenomas, is a primary cause.
• Hypothyroidism, renal failure, and other pituitary/hypothalamic lesions are less common etiologies.
• Discontinuation of causative medications is the first step in management.

Conclusions:

• Treatment for galactorrhea is not always necessary if hormone levels are normal and symptoms are not bothersome.
• Cabergoline is the recommended pharmacologic treatment for hyperprolactinemia.
• Surgical intervention is reserved for refractory cases or when dopamine agonist therapy is not tolerated.