Unilateral or bilateral non-puerperal galactorrhea

Specialty: Gynecology and breast.

• Milk secretion outside of pregnancy
• idiopathic galactorrhea
• pathological milk secretion

Why it occurs

• Drug-induced hyperprolactinemia (neuroleptics such as risperidone or haloperidol, metoclopramide, SSRI antidepressants)
• Prolactinoma (prolactin-secreting pituitary micro or macroadenoma)
• Primary hypothyroidism (elevated TRH directly stimulates pituitary lactotroph cells)
• Repeated mechanical stimulation of the chest wall or nipples (from burns, shingles, scars, or extreme friction)
• Idiopathic with normal prolactin levels (mammary receptor hypersensitivity)

Initial workup

Serum analytical determination of basal prolactin under resting conditions (avoiding stressful puncture and prior breast palpation). Determination of TSH and free T4. If prolactin is greater than 50-100 ng/mL or there is clinical neurological suspicion, a magnetic resonance imaging of the brain with contrast focused on the sella turcica is mandatory. Bilateral breast ultrasound to confirm that the secretion comes from healthy ducts without intracanalicular lesions.

Standard management

• Cabergoline starting with 0.25-0.5 mg orally per week, divided into one or two doses, with progressive titration according to prolactin levels — dopamine agonist of choice due to its excellent tolerance and efficacy profile
• Bromocriptine 1.25-2.5 mg orally daily as an alternative
• Withdrawal or replacement of the offending drug if the hyperprolactinemia is of pharmacological origin, under the supervision of the specialist who prescribed it (note: in small asymptomatic prolactinomas with normal-low prolactin and regular cycles, clinical monitoring without active treatment can be chosen).