Rotimi Adesanya
A worried mum sent a feedback last week about her 18-year-old daughter who complained of seeing what looks like milk coming out of her breasts. The mother was worried about the likelihood of pregnancy as she said she had a similar experience during her child-bearing days.
This complaint mentioned above is that of a condition called glactorrhea. It often results from having too much prolactin (the hormone responsible for milk production when a woman has a baby). Prolactin is produced by the pituitary gland, a small bean-shaped gland at the base of the brain, which secretes and regulates several hormones. Occasionally teenagers or young women may notice milky-white discharges from one or both breasts. This condition is called glactorrhea. It is an inappropriate lactation. Teenagers and young women with breast problems, such as galactorrhea, are often first seen by family physicians/primary care doctors, while older women are seen mainly by the gynaecologists because of the link between galactorhoea and infertility.
The true incidence of galactorrhea is unknown, but it is estimated that between 20 and 25 per cent of women experience it. Although it is not an emergency, one should make an appointment with the health care provider to get checked to find out the cause and get treated. Although rare, galactorrhea can also occur in males. Lactation requires the presence of oestrogen, progesterone and, most importantly, prolactin. Stress, suckling, sleep, sexual intercourse, and medications may increase prolactin levels.
Causes
Galactorrhea itself isn’t a disease, but it could be a sign of an underlying problem. It occurs more in older women than teenagers, even in those who have never had children or after menopause. It can also occur in men and infants. Excessive breast stimulation, medication side effects or disorders of the pituitary gland all may contribute to galactorrhea. Often, galactorrhea results from increased levels of prolactin, the hormone that stimulates milk production.
Other causes are side effects of certain medicines (such as drugs for mood disorders or rarely birth control pills), a hormonal imbalance (such as hypothyroidism or low thyroid hormone level), neurologic disorders, chronic kidney disease, numerous medications, chest wall irritation, frequent self-examination of the breast, with nipple manipulation or prolonged clothing friction, nerve damage to the chest wall from chest surgery, burns or other chest injuries, spinal cord surgery, injury or tumours and stress.
Symptoms
The signs and symptoms associated with galactorrhea include: Persistent or intermittent milky nipple discharge, nipple discharge involving multiple milk ducts, Spontaneously leaked or manually expressed nipple discharge, one or both breasts affected, absent or irregular menstrual periods, headaches or vision problems, Idiopathic galactorrhea, sometimes doctors can’t find a cause for galactorrhea. This is called idiopathic galactorrhea, and it may just mean that your breast tissue is particularly sensitive to the milk-producing hormone prolactin in your blood. If there is increased sensitivity to prolactin, even normal prolactin levels can lead to galactorrhea.
Galactorrhea in men
In males, galactorrhea may be associated with testosterone deficiency (male hypogonadism) and it usually occurs with breast enlargement or tenderness (gynecomastia). Erectile dysfunction and a lack of sexual desire also are associated with testosterone deficiency.
Galactorrhea in newborns
Galactorrhea sometimes occurs in newborns. High maternal oestrogen levels cross the placenta into the baby’s blood. This can cause enlargement of the baby’s breast tissue, which may be associated with milky nipple discharge. This milky discharge is temporary and resolves on its own. If the discharge is persistent, the newborn should be evaluated by a doctor.
Diagnosis
The evaluation includes a thorough history and physical examination, a pregnancy test, a prolactin level, renal and thyroid function tests and if indicated, magnetic resonance imaging of the brain.
Treatment
If breast stimulation, such as excessive nipple manipulation during sexual activity triggers nipple discharge from multiple ducts, there is little cause for worry. The discharge probably doesn’t signal anything abnormal, and this discharge often resolves on its own. Options for more serious causes like prolactinomas include observation, dopamine agonists, surgery and radiation therapy, Treatment and correction of hypothyroidism if the cause is from thyroid disorders. Due to the fact that the condition resolves on its own in most teenagers and young women without chronic illnesses, doctors are very careful in prescribing dopamine agonist to stop this milky discharge for this group of people. Also due to the side effects of the medications, doctors are also not in a hurry to prescribe drugs for these young women.
When to see a doctor
If there is a persistent, spontaneous milky nipple discharge from one or both breasts and the woman is not pregnant or breast-feeding, there is the need to make an appointment to see the doctor.
Also in cases of non-milky nipple discharge particularly bloody, yellow or clear spontaneous discharge that comes from one duct or is associated with a lump, it will require prompt medical attention, as it may be a sign of underlying breast cancer.
Rotimi Adesanya; Child and Public Health Physician, roayad@yahoo.com, 08037202050
[Punch]
