Galactorrhoea

Galactorrhea is a milk flow in men per se, or in women who do not breastfeed. It is almost always caused by a pituitary adenoma prolactinsezernierendes. The diagnosis is made by determining the prolactin and by imaging methods. The treatment comprises the administration of dopamine agonists and, occasionally, the removal or destruction of the adenoma.

Galactorrhea includes the secretion of breast milk. A discussion of nipple secretions in general, [is provided elsewhere

Galactorrhea is a milk flow in men per se, or in women who do not breastfeed. It is almost always caused by a pituitary adenoma prolactinsezernierendes. The diagnosis is made by determining the prolactin and by imaging methods. The treatment comprises the administration of dopamine agonists and, occasionally, the removal or destruction of the adenoma. Galactorrhea includes the secretion of breast milk. A discussion of nipple secretions in general, [is provided elsewhere etiology a Galactorrhea is almost always caused by a pituitary adenoma prolactinsezernierendes (prolactinoma). Most tumors in women are microadenomas (<10 mm in diameter), but a small percentage are macroadenoma (> 10 mm) when they are diagnosed. The presence of microadenomas in men is much less common, perhaps only because they are noticed later. Non-working Hypophysenmassenläsionen can also increase the levels of prolactin by the compression of the pituitary stalk and thus the effect of dopamine, a prolactin inhibitor, reduce. Hyperprolactinemia and galactorrhea may also be caused by certain medications, such. For example, by phenothiazines, other antipsychotics, certain antihypertensive agents (especially Alpha-methyldopa) and opioids. A primary hypothyroidism can cause hyperprolactinemia and galactorrhea as increased levels of thyroid-stimulating hormone-releasing hormone accurately as thyroid-stimulating hormone (TSH) can increase the prolactin secretion. It remains unclear why a hyperprolactinemia is associated with a Hypogonadotropismus and hypogonadism (see Table: Causes of hyperprolactinemia). Causes of hyperprolactinemia cause example Physiologically nipple stimulation in women pregnancy postpartum stress eating intercourse in women sleep hypoglycemia infancy (up to 3 months) Hypothalamic disorders Hypothalamic tumors non-tumorous hypothalamic infiltration: sarcoidosis, TB, Langerhans cell histiocytosis (Hand-Schuller-Christian Disease) post encephalitis Idiopathic galactorrhea (presumably pathological dopamine) traumatic brain injury Pituitary disease Prolaktinsezernierende pituitary tumors, which lead to a compression of the pituitary stalk surgical transection of the pituitary stalk and other lesions of the pituitary stalk syndrome empty sella Other endocrine disorders Acromegaly Cushing’s disease Primary hypothyroidism interference with other systems Chronic kidney failure liver disease Ectopic prolactin: lung cancer (non-squamous; mostly undifferentiated small cell carcinomas) Hypernephrome lesions of the chest wall Surgical scars trauma tumors herpes zoster Pharmacologically antihypertensives: Resperine, alpha-methyldopa, labetalol, atenolol, verapamil, clonidine H2 antagonist (eg ranitidine) Oral contraceptives and estrogens opioids psychotropic drugs, for.. As phenothiazines, tricyclic antidepressants and other, Butyrphenone (haloperidol), benzamides (metoclopramide, sulpiride) thyrotropin releasing hormone data from Rebar RW: Practical evalutation of hormonal status. In: Reproductive Endocrinology: Physiology, Pathophysiology and Clinical Management, edited by SSC Yen and Jaffe RB. Philadelphia, WB Saunders Company, 1978, p. 493. Symptoms and signs A pathological milk flow is not defined quantitatively; there is a milk flow that is inappropriate, persistent or worrisome for the patient. A spontaneous flow of milk is in contrast to a milk flow by manipulating rare. The milk is white. In women with galactorrhea often finds amenorrhea or oligomenorrhea. Women with galactorrhea and amenorrhea may also have symptoms of estrogen deficiency, including dyspareunia, which is due to an inhibition of the pulsatile release of luteinizing and follicle stimulating hormone by the high prolactin levels. Nevertheless, the estrogen levels may be normal and clinical signs of androgen excess can occur in some hyperprolactinemic women. Hyperprolactinemia can with disorders of the menstrual cycle on the amenorrhea addition, including rare ovulation and luteal dysfunction associated. Men with prolactinsezernierenden pituitary tumors typically have headaches or blurred vision. About two thirds of sufferers complain of loss of libido and erectile dysfunction. Diagnosis prolactin thyroxine (T4) and TSH levels CT or MRI Diagnosis of galactorrhoea by prolactinsezernierende pituitary tumors is based on the finding of increased prolactin levels (typically> 5 times higher than normal, sometimes much higher) and the decrease in lesion size in response to the treatment , In general, the prolactin levels correlate with the size of pituitary tumors and are the perfect follow-up parameters for the detection of recurrence. In a non-working Hypophysenmasse prolactin levels are usually not> 3 times to 4 times higher than normal. A test run of a dopamine agonist therapy can help to distinguish between prolactin secreting and non-functioning lesions; In both types of lesions prolactin levels take after treatment, but prolactin-secreting lesions lose size, while this does not apply to non-functioning lesions. Serumgonadotropin- and estradiol levels are either decreased or in the normal range at hyperprolactinemic women. A primary hypothyroidism can be easily ruled out by the absence of an elevated TSH. A high-resolution CT or better MRI is the method of choice to discover microadenomas. In macroadenomas and especially in patients who opt for drug therapy or waiting and observing a visual field examination is indicated. Therapy Depending on gender, cause, symptoms and other factors, the treatment of Mikroprolactinomen is controversial. In asymptomatic patients prolactin level below 100 ng / ml and normal CT or MRI findings show or those which have only microadenomas, probably sufficient follow-up observations. Often the Serumprolactinspiegel normalize over the years. Patients with hyperprolactinemia should be followed up by determining the prolactin quarterly and annual Sella CT or -MRT at least 2 years. The frequency of Sella imaging can be reduced if the prolactin levels do not increase. In women, the treatment indications pregnant amenorrhea or significant oligomenorrhea include (because of the risk of osteoporosis) hirsutism Low Libido Disturbing galactorrhea in men is a rare galactorrhoea even disturbing enough to require treatment; to the indications for treatment include hypogonadism (because of the risk of osteoporosis) Erectile dysfunction Low libido Interfering infertility treatment of choice is generally the administration of a dopamine agonists such as bromocriptine (1.25 to 5 mg po 2 times a day) or longer-acting cabergoline (0.25-1.0 mg po 1 to 2 times a week), which reduces prolactin. Cabergoline is the treatment of choice because it is obviously better tolerated and more effective than bromocriptine. Women who want children should change a month before the planned approach to bromocriptine and stop taking bromocriptine at the time of a positive pregnancy test result at the latest. With long-term use, the safety profile of bromocriptine is better than for cabergoline, although evidence of the safety of cabergoline accumulate. Women with a microadenoma and estrogen deficient can be treated in the absence of desire for children with estrogens. Estrogen replacement may not link to tumor growth. Quinagolide, a nichtergolin derived dopamine agonist, is also a possibility with hyperprolactinemia. It is po at a dose of 25 micrograms started 1 time / day and for 7 days in the usual maintenance dose of 75 ug 1 time / day titrated (maximum dose 600 ug 1 time / day). Patients with macroadenomas should be generally associated with dopamine agonists or treated surgically after carefully pituitary function and the possibility of radiotherapy was reviewed previously. Dopamine agonists are usually the initial treatment of choice and shrink a prolactin-secreting tumors, but not a non-functioning tumors, which causes compression of the pituitary stalk usually, although the prolactin levels decrease. If prolactin levels fall and the symptoms subside a tumor compression, it may be that no further treatment is necessary. However, larger non-functioning lesions usually require additional treatment, usually a surgery. Surgical resection or radiation therapy can be carried out more easily or often successful, having already been caused by a dopamine agonist tumor regression. Although treatment with dopamine agonists usually must be continued in the long term, there will either spontaneously or perhaps by drug therapy supported remission prolactin-secreting tumors. Occasionally dopamine agonists can therefore be discontinued without causing a tumor recurrence or an increase in prolactin levels. Remission is at microadenomas likely than macroadenomas. Likewise, remission is more likely after pregnancy. High doses of dopamine agonists, especially cabergoline and pergolide, are probably the cause of valvular heart disease in some patients with Parkinson’s disease. It is not clear whether lower doses of dopamine agonists increase the risk of heart valve disease just in hyperprolactinemia, but the possibility should be discussed with the patient and echocardiographic monitoring should be considered. The risk may be lower with bromocriptine or quinagolide. Dopamine agonists sometimes cause in the materials used for hyperprolactinemia doses also behavioral and psychological changes, which are characterized by an increased impulsivity and sometimes psychosis, which limits their use in some patients. Radiation therapy should be performed in patients with tumor progression or treatment failure. After radiation therapy is often a hypopituitarism developed after several years. The review of the endocrine function and (Editor’s note: if any) a Sella representation should be held for life once a year. Important points Galactorrhea is a milk flow that is inappropriate, persistent or worrisome for the patient. The most common cause is a pituitary tumor, but many drugs and diseases of the endocrine system and the hypothalamus and other disorders may be responsible. The prolactin levels are measured, and an imaging of the CNS is performed to detect a causative tumors. In Mikroprolactinomen a dopamine agonist is administered when certain disturbing symptoms are present. In macroadenomas a dopamine agonist is administered and pulled a surgical ablation or sometimes radiation therapy considered.

Health Life Media Team

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