CAUSES
. Pituitary gland overproduction
. Prolactinoma, acromegaly, empty sella, lymphocytic hypophysitis
. Hypothalamic region dysregulation
. Craniopharyngiomas, meningiomas, dysgerminomas, tumors, sarcoid, irradiation, vascular insult, stalk disruption or dissection
. Medications that suppress dopamine
. Phenothiazines, SSRIs, TCAs, Butyrophenones, cimetidine, ranitidine, reserpine, alpha methyl-dopa, verapamil, estrogens, isoniazid, opioids, stimulants,
neuroleptics, metoclopramide
. Chest wall conditions
. Zoster, fi brocystic breast disease, surgical or other trauma
. Post surgical condition especially oophorectomy
. Other causes
. Primary hypothyroidism, cirrhosis, Cushing disease, ectopic prolactin secretion, renal failure, sarcoid, lupus, multiple sclerosis, polycystic ovary syndrome
. Physiologic with pregnancy or up to 6 months after stopping lactation
. Chiari-Frommel - idiopathic galactorrhea more than six months postpartum
. Idiopathic - normal prolactin levels
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D.D. :
1. DUE TO FAILURE OF THE NORMAL HYPOTHALAMIC INHIBITION OF PROLACTIN RELEASE
A. PITUITARY STALK SECTION
B. DRUGS LIKE PHENOTHIAZINES, BUTYROPHENONES, METHYLDOPA, TRICYCLIC ANTIDEPRESSANTS, OPIATES, RESERPINE, VERAPAMIL, PAROXETINE, RISPIRADONE, METOCLOPRAMIDE, SERTRALINE, METHYLDOPA, ANTIEMETICS, VIRTUALLY ALL PSYCHOTROPIC DRUGS, ORAL CONTRACEPTIVES HAVING OESTROGENS
C. CNS DISEASES INCLUDING EXTRAPITUITARY TUMORS BY INTERFERING WITH THE PRODUCTION OR DELIVERY OF DOPAMINE TO PITUITARY
- CNS SARCOIDOSIS
- CRANIOPHARYNGIOMA
- PINEALOMA
- ENCEPHALITIS
- MENINGITIS
- HYDROCEPHALUS
- HYPOTHALAMIC TUMORS
- NULL CELL ADENOMAS OF THE PITUITARY
2. DUE TO INCREASED PROLACTIN-RELEASING FACTOR(S)
* HYPOTHYROIDISM
* SUCKING REFLEX & BREAST TRAUMA
3. DUE TO AUTONOMOUS PROLACTIN SECRETION BY TUMORS
A. PITUITARY TUMORS
- PROLACTIN SECRETING TUMORS
- MIXED GROWTH HORMONE & PROLACTIN SECRETING TUMORS
- NULL CELL ADENOMAS
B. ECTOPIC PRODUCTION OF HUMAN PLACENTAL LACTOGEN AND / OR PROLACTIN
- HYDATIFORM MOLES & CHORIOCARCINOMAS
- BRONCHOGENIC CARCINOMA & HYPERNEPHROMA
4. IDIOPATHIC
• Confirm microscopic of secretions is lipoid
• Check prolactin level and thyroid functions
• Check pregnancy test, liver and renal functions
• Consider FSH/LH if amenorrheic
• Consider growth hormone levels if acromegaly suspected
• Check adrenal steroids if signs of Cushing disease
SPECIAL TESTS
• Formal visual field testing if pituitary adenoma suspected
• Progesterone withdrawal bleed if amenorrheic
IMAGING Pituitary MRI (CT, coned-down views or tomograms are substandard)
* SERUM PROLACTIN LEVELS -( 20 - 100 NG / ML )- IN DRUG INDUCED GALACTORRHEA, PITUITARY, HYPOTHALAMIC, PARASELLAR CAUSES.
* SERUM PROLACTIN LEVELS -( > 200 NG / ML ) - PREGNANCY, PROLACTINOMA
* URINE PREGNANCY TEST- TO EXCLUDE NORMAL PREGNANCY
* TSH - PRIMARY HYPOTHYROIDISM CAN PRESENT AS AMENORRHEA-GALACTORRHEA SYNDROME