Delayed pituitary enhancement breast discharge-Diagnosis and Management of Galactorrhea - American Family Physician

Skip to Content. Use the menu to see other pages. People with a pituitary gland tumor may experience the following symptoms or signs. Sometimes, people with a pituitary gland tumor do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not a pituitary gland tumor.

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge

Stimuli are thought to Delayed pituitary enhancement breast discharge along the intercostal nerves to the posterior column of the spinal cord, to the mesencephalon, and finally to the hypothalamus, where the secretion of prolactin inhibitory factor is reduced. Side effects of these medications commonly include nausea, dizziness and headaches. Galactorrhea caused by breast stimulation is more common in parous women but has been reported in virgins, postmenopausal women, and men. Delayed pituitary enhancement breast discharge Gynecol Clin North Am. The condition is more common in women who are 20 to 35 years of age and in previously parous women; it is less common in children and nulligravid Sex offenders registry european. A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients. Duct ectasia is most frequently associated with pain, itching, and swelling in the nipple. Accessed Oct. If your prolactin level is elevated, your doctor will most likely check your thyroid-stimulating hormone TSH level, too. Duct ectasia or comedomastitis can produce a multicolored, sticky discharge that is commonly bilateral in the perimenopausal woman.

Essex house westin hotel. Pituitary Gland Tumor: Symptoms and Signs

Competing interests The authors declare that they have no competing interests. Symptoms remitted during a 5-day hospitalization with olanzapine and lithium. The growth hormone receptor antagonist, pegvisamont, may prove more effective and can be used in combination with other agents If the doctor goes under your lip or through your nose, you will probably leave the hospital in 1 to 3 days. This, in turn, causes an increase in serum prolactin levels, and mimics a prolactinoma, i. Bj nathan south PA : Lippincott-Raven; B US image shows the lobulated, fat-fluid arrows galactocele. Lactating brfast is composed of acinars and mature thin tubes and filled with secretion is softer than a fibroadenoma The physiological changes that occurs in the surrounding normal parenchyma takes place in the lesions of dischwrge internal secretion and Delayed pituitary enhancement breast discharge hyperplasia appears [ 49 - 51 ddischarge. Check Delayed pituitary enhancement breast discharge errors and try again. Losa, M.

Breast development , also known as mammogenesis , is a complex biological process in primates that takes place throughout a female's life.

  • She endorsed sleep-deprived energy enhancement, unfulfilled goal-oriented productivity, hyper-talkativeness, hyper-sexuality and increased nicotine use.
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  • Pituitary adenoma is a benign noncancerous tumor of the neuroendocrine epithelial cells of the pituitary gland and they do not spread to other parts of the body 1.

NCBI Bookshelf. Boston: Butterworths; Nipple discharge is the passage of liquid material through the nipple either spontaneously or with manipulation of breast tissue. Important history to elicit from the patient is bilaterality or unilaterality of the discharge and association with other symptoms, such as mass, pain, skin or nipple changes.

A careful gynecologic history should be obtained, including recent pregnancies, contraceptive use, menstruation abnormalities and past breast biopsies, infections, or cancers. It is crucial to ask the patient about current drug usage and local irritative factors to the nipples e. A systematic, thorough palpation of both breasts and axillary regions with nipple examination and expression of the discharge should always be conducted.

Cytologic examination, occult blood testing, and Wright staining of the discharge are suggested. The human breast has a tubuloalveolar structure and consists of 15 to 25 lobes radiating from the nipple.

Each lobe is subdivided into lobules from which emerge lactiferous ducts. True discharge comes through mammary ducts out the nipple and may be noted to drain spontaneously and stain clothing, or may be elicited by segmental palpation of breast tissue. Differentiation of the seven basic types of nipple discharge can be determined by observation of the color of discharge, palpation of discharge to determine texture, and smear examination of discharge with Wright's stain to see if pus or blood is present.

Discharge from the breast is an abnormal finding except in late pregnancy or the postpartum period. There are seven basic types of nipple discharge, each of which can be associated with specific clinical conditions. Galactorrhea, or nonpuerperal lactation, usually results from multiple duct discharge from both breasts.

The etiology of galactorrhea can be classified in terms of prolactin abnormalities. Galactorrhea associated with high prolactins can be caused by failure of the normal hypothalamic inhibition of prolactin release, enhanced prolactin-releasing factor, or autonomous or ectopic prolactin-releasing factor.

Lesions in the hypothalamus, pituitary stalk section or drugs that influence the central nervous system can decrease the inhibitory dopaminergic control of prolactin.

Common drugs interfering with prolactin inhibition are psychotropic drugs butyrophenones, phenothiazines , antihypertensives reserpine, alpha-methyldopa , cannabinoids and opiates marijuana, morphine, heroin , contraceptives, and metoclopropamide.

A physiologic enhancement of prolactin release is caused by thyrotropin releasing hormone TRH. Primary hypothyroidism resulting in increases of TRH can cause prolactin release and galactorrhea that can be cured by thyroid hormone replacement.

Three types of pituitary tumors may be associated with galactorrhea: pure prolactin-secreting tumors micro- or macroadenoma , mixed tumors that secrete both growth hormone and prolactin, and chromophobe adenomas.

Prolactin can also be rarely secreted by other malignancies, such as bronchogenic carcinoma, hydatidiform moles, chorio-carcinomas, and hypernephromas. The majority of patients with galactorrhea will have normal prolactins. Irritative nipple stimulation or breast manipulation can cause galactorrhea with mildly elevated or normal prolactins.

One-third of normal nonpostpartum women will raise serum prolactin after repetitive breast stimulation. Postpartum women can lactate with normal ovulatory function for one or more years following pregnancy, especially with breast manipulation. Duct ectasia or comedomastitis can produce a multicolored, sticky discharge that is commonly bilateral in the perimenopausal woman.

It begins as a dilation of the terminal ducts with an irritating lipid fluid collecting and producing an inflammatory reaction resulting in discharge from the nipple.

Duct ectasia is most frequently associated with pain, itching, and swelling in the nipple. Palpation of the areola can often reveal a tubular mass, reflecting the dilated ducts. Often a history of nipple manipulation can be elicited. If the disease progresses, a mass can develop plasma cell mastitis that can mimic cancer. Surgery is indicated only if a mass forms or the discharge changes to serosanguinous or bloody. In patients with acute puerperal mastitis, chronic lactation mastitis, central breast abscesses, or plasma cell mastitis, pus can be discharged, usually unilaterally.

Breast cultures and smears may reveal an organism responsible. Abscess formation usually requires incision and drainage if appropriate antibiotics and local soaks do not have effect. It is important to remove a portion of an abscess wall for histologic study to rule out the possibility of an underlying cancer with secondary necrosis and infection.

The most common cause of these discharges is intraductal papillomas, but fibrocystic disease, advanced duct ectasia, cancer of the breast, and vascular engorgement in near-term pregnancy can also be causative. In a series of patients with watery, serous, serosanguinous, or bloody discharge, In patients over the age of 50, malignancy becomes increasingly common, especially if the discharge is unilateral and associated with a mass.

Surgical exploration is mandatory in the group of patients with this type of discharge, even if cytologic and mammographic findings are negative. Turn recording back on. National Center for Biotechnology Information , U. Boston: Butterworths ; Search term. Chapter Nipple Discharge Michele Barry. Definition Nipple discharge is the passage of liquid material through the nipple either spontaneously or with manipulation of breast tissue.

Technique Important history to elicit from the patient is bilaterality or unilaterality of the discharge and association with other symptoms, such as mass, pain, skin or nipple changes. Basic Science The human breast has a tubuloalveolar structure and consists of 15 to 25 lobes radiating from the nipple.

Clinical Significance Discharge from the breast is an abnormal finding except in late pregnancy or the postpartum period. Milky—white discharge; fat globules sometimes observed under microscopy. Milky Discharge Galactorrhea, or nonpuerperal lactation, usually results from multiple duct discharge from both breasts. Multicolored and Sticky Discharge Duct ectasia or comedomastitis can produce a multicolored, sticky discharge that is commonly bilateral in the perimenopausal woman.

Purulent Discharge In patients with acute puerperal mastitis, chronic lactation mastitis, central breast abscesses, or plasma cell mastitis, pus can be discharged, usually unilaterally. Watery, Serous, Serosanguinous, and Bloody Discharges The most common cause of these discharges is intraductal papillomas, but fibrocystic disease, advanced duct ectasia, cancer of the breast, and vascular engorgement in near-term pregnancy can also be causative.

References Atkins H, Wolff B. Discharge from the nipple. Br J Surg. The significance of nipple discharge. N Engl J Med. Prolactin release during nursing and breast stimulation in postpartum and nonpostpartum subjects. J Clin Endocrinol Metab. Nipple discharge. The breast. Louis: CV Mosby, ;— Nonlactational nipple discharge. Breast Dis Breast. Nipple Discharge. Chapter In this Page. Related information. PubMed Links to PubMed. Similar articles in PubMed. Bloody nipple discharge in infancy: a case report and recommendations for management.

J Pediatr Adolesc Gynecol. Epub Sep Review Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis. Breast Cancer Res Treat. Post-operative seroma causing spontaneous nipple discharge: diagnosis by galactography.

J Radiol Case Rep. Epub May 1. Retrospective analysis of pathologic nipple discharge. Genet Mol Res. Epub Feb Review Management of nipple discharge and the associated imaging findings.

Am J Med. Epub Oct Recent Activity. Clear Turn Off Turn On. Nipple Discharge - Clinical Methods. Support Center Support Center. External link. Please review our privacy policy.

Gestational breast cancer. Breastfeeding cessation disrupts biorhythms and dopamine quiescence Lyons et al. The ultrasound appearances of galactocoeles. Surgery provides prompt relief from excess hormone secretion and mass effect. The soporific effects of prolactin and oxytocin facilitate rest after nighttime nursing World Health Organization Breast Cancer Res Treat. The decrease in hypothalamic dopamine secretion induced by suckling: comparison of voltammetric and radioisotopic methods of measurement.

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge. Introduction

Testosterone levels can be measured directly. An endocrinologist can test for causes of low testosterone, including elevated prolactin levels.

Sometimes other blood tests are indicated to make the diagnosis or determine the cause, including free testosterone, sex hormone binding globulin, leutinizing hormone LH or evaluation for Cushing's disease or acromegaly. If the underlying cause of the low testosterone can be determined and corrected, testosterone levels often rise to normal levels. Medical treatment to lower prolactin levels from a prolactinoma often results in normalization of testosterone level.

Cure of acromegaly or Cushing's disease also often results in normalization of testosterone levels. In patients for whom the cause cannot be determined or addressed, testosterone replacement therapy can be prescribed by an endocrinologist with expertise in this area. There are a number of different preparations available, including gels, creams, patches, and injections.

Your endocrinologist can discuss the pros and cons of the different options with you. If bone density does not improve when testosterone has been normalized, additional medications may be necessary. There are no FDA-approved testosterone preparations for women, who make 10 to 20 times less testosterone than men and therefore need much lower replacement doses than men. Research is ongoing in the Neuroendocrine Unit on the effects of low testosterone and testosterone treatment in both men and women.

Hypogonadism Information. For a neurosurgical appointment, email Dr. Brooke Swearingen or call A copy of your lab reports. Bring any medications you are taking with you to your appointment. Please make sure your MGH registration is accurate and up-to-date. Rarely they can be an incidental finding, however as by their very nature microadenomas are difficult to identify on anything other than dedicated pituitary imaging. Historically, before the advent of MRI, the pituitary was imaged with lateral skull x-rays looking for remodeling of the pituitary fossa , and later with CT.

MRI is the mainstay of imaging for pituitary microadenomas, and required dedicated pituitary sequences thin slice, small field of view, dynamic contrast acquisition. Post contrast and especially thin section dynamic contrast-enhanced imaging is an important part of a pituitary MRI and has significantly improved diagnostic accuracy 2,3.

Some often subtle morphology changes can be identified on non-contrast images, however. These include bulkiness of the gland on the side of the microadenoma, subtle remodeling of the floor of the sella, deviation of the pituitary infundibulum away from the adenoma 2.

Inferior petrosal sinus sampling is now reserved for one of two situations where patients are suspected of having a pituitary microadenoma, despite normal MRI:. The differential is broadly that of other pituitary regions masses, but is predominantly composed of:. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait.

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Articles Cases Courses Quiz. About Blog Go ad-free. Pituitary microadenoma A. On this page:. Quiz questions. Handbook of neuro-oncology neuroimaging. Academic Pr.

Galactorrhea - Diagnosis and treatment - Mayo Clinic

Patient Information Handout. After infancy, galactorrhea usually is medication-induced. The most common pathologic cause of galactorrhea is a pituitary tumor. Other causes include hypothalamic and pituitary stalk lesions, neurogenic stimulation, thyroid disorders, and chronic renal failure.

Patients with the latter conditions may have irregular menses, infertility, and osteopenia or osteoporosis if they have associated hyperprolactinemia. Tests for pregnancy, serum prolactin level and serum thyroid-stimulating hormone level, and magnetic resonance imaging are important diagnostic tools that should be employed when clinically indicated.

The underlying cause of galactorrhea should be treated when possible. Dopamine agonists are the treatment of choice in most patients with hyperprolactinemic disorders. Bromocriptine is the preferred agent for treatment of hyperprolactin-induced anovulatory infertility. Although cabergoline is more effective and better tolerated than bromocriptine, it is more expensive, and treatment must be discontinued one month before conception is attempted. Surgical resection rarely is required for prolactinomas.

The secretion may be intermittent or persistent, scant or abundant, free-flowing or expressible, and unilateral or bilateral. The condition is more common in women who are 20 to 35 years of age and in previously parous women; it is less common in children and nulligravid women.

Galactorrhea also can occur in men. In children, galactorrhea is more common in infants and teenage girls. Cabergoline Dostinex is significantly more effective and better tolerated than bromocriptine Parlodel.

Bromocriptine is the drug of choice when treatment is aimed at hyperprolactin-induced anovulatory infertility. Magnetic resonance imaging of the pituitary fossa should be performed if the serum prolactin level is significantly elevated or if there is any suspicion of a pituitary tumor.

Pharmacologic agents are a common cause of galactorrhea. Some medications known to cause galactorrhea are listed in Table 1. Estrogen in oral contraceptives can cause galactorrhea by suppressing the hypothalamic secretion of prolactin inhibitory factor and by direct stimulation of the pituitary lactotrophs.

Galactorrhea also may develop following estrogen withdrawal because of the absence of the inhibitory effect on prolactin action at the breast. Information from references 2 and 3. Pituitary tumors, the most common pathologic cause of galactorrhea, 5 can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Prolactinomas are the most common type of pituitary tumor 6 and are associated with galactorrhea, amenorrhea, and marked hyperprolactinemia.

The serum level of prolactin usually correlates with the size of the tumor. Hypothalamic lesions such as craniopharyngioma, primary hypothalamic tumor, meta-static tumor, histiocytosis X, tuberculosis, sarcoidosis and empty sella syndrome, and pituitary stalk lesions—traumatic or secondary to the mass effects of sellar tumors—are infrequent but significant causes of galactorrhea.

These lesions destroy dopamine-producing neurons in the hypothalamus and block the passage of dopamine from the hypothalamus to the pituitary gland. Primary hypothyroidism is a rare cause of galactorrhea in children and adults. Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, 13 possibly because of decreased renal clearance of prolactin.

Although galactorrhea in these patients is rare, it can result from the elevated prolactin levels. Neurogenic stimulation may repress the secretion of hypothalamic prolactin inhibitory factor, which results in hyperprolactinemia and galactorrhea. Galactorrhea may be caused by prolonged, intensive breast stimulation, such as from suckling, self-manipulation, or stimulation during sexual activity.

Galactorrhea caused by breast stimulation is more common in parous women but has been reported in virgins, postmenopausal women, and men. Neurogenic causes of galactorrhea include chest surgery, burns, and herpes zoster that affects the chest wall. Stimuli are thought to pass along the intercostal nerves to the posterior column of the spinal cord, to the mesencephalon, and finally to the hypothalamus, where the secretion of prolactin inhibitory factor is reduced.

Galactorrhea may develop as a complication of spinal cord injury. High levels of estrogens in the placental-fetal circulation can result in gynecomastia in newborn infants. In one large-scale study of examinations of healthy infants from birth to two months of age, galactorrhea was found in 45 examinations 4.

Idiopathic galactorrhea is a diagnosis of exclusion. Galactorrhea is considered idiopathic if no cause is found after a thorough history, physical examination, and laboratory evaluation. A thorough history Table 2 and physical examination Table 3 can provide important clinical clues in the evaluation of patients with galactorrhea. Headache, visual disturbances, temperature intolerance, seizures, disordered appetite, polyuria, polydipsia.

Nervousness, restlessness, increased sweating, heat intolerance, weight loss in spite of an increase in appetite. Onset in the neonatal period signals transplacental transfer of maternal estrogen with resultant gynecomastia. Patients with prolactinomas usually are 20 to 35 years of age.

In general, the longer the duration of galactorrhea without the development of other clinical signs, the less likely the possibility of an underlying organic disease.

A milky discharge is characteristic of galactorrhea. A bloody, serosanguineous, or purulent discharge should be regarded as pathologic and is distinct from galactorrhea. Galactorrhea usually is bilateral, whereas a pathologic discharge usually is unilateral. Physicians also should note whether the discharge is scant or abundant, expressed or spontaneous, and intermittent or persistent.

Head-aches, visual disturbances, temperature intolerance, seizures, disordered appetite, polyuria, and polydipsia suggest a pituitary or hypothalamic disease. Decreased libido, infertility, oligomenorrhea or amenorrhea, and impotence may indicate hyperprolactinemia.

Nervousness, restlessness, increased sweating, heat intolerance, and weight loss despite an increase in appetite suggest thyrotoxicosis. A detailed menstrual history and a history of pregnancies, recent abortions, and sexual activities are essential.

Amenorrhea may indicate pregnancy or a pituitary tumor. Breast stimulation by clothing, suckling, self-manipulation, or stimulation during sexual activity should be noted. In infants, breastfeeding history should be noted, because galactorrhea is more common in breastfed infants. A detailed drug history is crucial; galactorrhea is associated with a wide variety of drugs that raise serum prolactin levels.

Oral contraceptives are the most common pharmacologic cause of galactorrhea. Recent chest surgery and significant illnesses such as hypothyroidism, thyrotoxicosis, and chronic renal failure should be noted. A family history of thyroid disorder or multiple endocrine neoplasia type I suggests a corresponding disorder. Approximately 30 percent of patients with multiple endocrine neoplasia type I have pituitary tumors; prolactinoma is the most common.

Poor growth may indicate hypopituitarism, hypothyroidism, or chronic renal failure. The chest should be inspected for any sign of local irritation, infection, or trauma. The breasts should be examined for nodules and discharge.

It is important to determine whether the discharge is confined to one duct and to ascertain its location. Visual field defect, papilledema, and cranial neuropathy suggest a pituitary tumor or an intracranial mass. The presence of goiter, coarse hair, dry skin, carotenemia, and myxedema indicates hypothyroidism. In contrast, the presence of goiter, hand tremor, and exophthalmos suggests thyrotoxicosis.

Hirsutism and acne may be associated with chronic hyperandrogenism associated with hyperprolactinemia. If there is doubt about the nature of the nipple discharge, galactorrhea can be confirmed by microscopic examination of the discharge for the presence of fat globules, or the discharge can be stained to detect fat.

A pregnancy test should be considered for all postpubertal females. If the diagnosis is not obvious, levels of serum prolactin, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone should be measured. Because the secretion of prolactin is labile and episodic, an elevated prolactin level should be confirmed on at least two occasions when the patient is in a fasting, non-exercised state, with no breast stimulation.

There is a direct correlation between the degree of hyperprolactinemia and the likelihood of finding a prolactin-secreting pituitary tumor. A serum prolactin level greater than ng per mL mcg per L virtually assures the presence of a prolactinoma. Magnetic resonance imaging MRI of the pituitary fossa, preferably with gadolinium enhancement, should be considered if the serum prolactin level is significantly elevated or if a pituitary tumor is suspected.

Osteopenia and osteoporosis may be associated with hyperprolactinemia in children and adults as a result of estrogen inhibition in females and disturbances of vitamin D hydroxylation in both sexes. Treatment of galactorrhea should be directed at the underlying cause. If possible, galactorrhea-inducing medications should be replaced with safe, alternative agents. Hypothyroidism should be treated with thyroid hormone replacement therapy.

Self-manipulation of the breast should be stopped. Galactorrhea secondary to maternal estrogen in infants is self-limited and does not require treatment. Algorithm for the management of prolactinoma in women. Clinical practice. N Engl J Med ; Patients with isolated galactorrhea and normal prolactin levels do not require treatment if they are not bothered by the galactorrhea, do not wish to conceive, and do not show evidence of hypogonadism or reduced bone density.

In patients with hyperprolactinemia, prolactin levels should be monitored, and MRI should be performed every two years 4 more often if a pituitary tumor is suspected.

Indications for treatment include the presence of significant symptoms such as bother-some or disabling galactorrhea, diminished libido, amenorrhea, and infertility; the presence of visual field defect and cranial nerve palsy; and abnormal test results such as detection of a pituitary tumor, osteopenia, or osteoporesis. Dopamine agonists are the preferred treatment for most patients with hyperprolactinemic disorders 24 , 25 ; these agents are extremely effective in lowering serum prolactin levels, eliminating galactorrhea, restoring gonadal function, and decreasing tumor size.

Food and Drug Administration for the treatment of hyperprolactinemia. Bromocriptine is a semisynthetic ergot derivative of ergoline, a dopamine D 2 -receptor agonist with agonist and antagonistic properties on D 1 receptors. Bromocriptine is the preferred agent in patients with hyperprolactin-induced anovulatory infertility. Cabergoline is an ergoline derivative with a high affinity and selectivity for D 2 receptors. Although no detrimental effects on fetal outcomes have been reported in more than pregnant women taking cabergoline, the current recommendation is to discontinue cabergoline one month before conception is attempted.

Because of the inherent risks of surgery and the efficacy of dopamine agonists in treating patients with prolactinoma, surgical resection rarely is required. Already a member or subscriber? Log in.

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge

Delayed pituitary enhancement breast discharge