I. Inhibition of PIF
1. Stress . Prolonged suckling . Jug & run
2. Thoracotomy scars . Cervical spine lesions . Herpes zoster
3. Drugs 4. Chronic renal failure
5. CNS disease 6. Pituitary stalk lesions
II. Stimulation of PRF
III.Increased prolactin production
1. Pituitary tumor 2. Non pituitary tumor
The most common cause of galactorhea.
The commonest are metaclorpromide & phenothiazines
I. Estrogens & drugs that increase estrogen
1. OCP 2. Digitalis
3. Marijuana 4. Heroin
II. Dopamine receptor blockers
3. Metaclorpromide 4. Isoniazide
III. CNS dopamine depleters
1. Psychoactive:Tricyclic antidepressant,phenothiazines,
2. Antihypertensive: Reserpin, Methyl dopa, verapamil
When galactorrhea disappear ?: 3-6 moAboubakr Elnashar
When to investigate ?
2. 12 mo after last pregnancy or weaning
Galactorrhea without hyperprolactinamia:
1. Episodic fluctuation & sleep increments
2. Bioactive PRL which is not detectable
3. An earlier episode of hyperprolactinaemia which
triggered persistent galactorrhea.
Hyperprolactinaemia without galactorrhea
1. Inadequate detection
2. Hypoestrogenic state.
3. Inadequate estrogenic or progetational priming of the
4. High PRL does not interact with the breast receptors
History & Examination: Exclude: Recent pregnancy, breast stimulation
Drugs, Breast or chest lesion
>20 ng/ml <20 ng/ml
Normal High (hypothyroidism)
MRI (Normal or hyperplasia, Microadenoma or Macroadenoma)Aboubakr Elnashar
after 60 min rest
not in late follicular phase
2nd blood sample if the first is raised
> 100 ng/ml: 60% pituitary tumor.
> 300 ng/ml: 100% pituitary tumor
Modest elevation can be associated with pituitary tumor
I. Idiopathic (normal PRL)
. Dopamine agonist (anxiety, pregnancy). Stop during pregnancy
. Observation: annual PRL
. Dopamine agonist (anxiety, pregnancy). Stop after 2-3 yr.
. Surgery (rapid growth).
Transsphenoidal microsurgery is very safe, but recurrence is high (Sperof,1999)
. Dopamine agonist: long term
. Surgery (No response, suprasellar extension, pregnancy).
Preoperative bromocriptine may result in fibrosis
usually do not enlarge significantly during pregnancy
may grow rapidly & cause visual disturbance during
Surgery before pregnancy should be considered.
An alternative method is continuation of dopamine
agonist during pregnancy: & visual field/ 3 mo: No
detrimental effects on the fetus, Nearly all delivered at
term without complications
Pregnancy, Breast feeding, COC s, ERT
not contraindicated Aboubakr Elnashar
(Parlodel, lactodel, Dopagon , 2.5 mg)
Dose:1 t bid
Side effects: n & v. , postural hypotension, headache,
nasal stiffness, constipation.
Can be minimized: give t at bed time, avoid large dose
increament, vaginal adminstration
Monitoring: mid normal values, titrate the dose
Galactorhea stops after: 6 w & 11 w if there is adenoma
Vaginal: Absorption is almost complete & slow, the first
pass through the liver is avoided: 1 t /d & less side
effects. During menstruation: tampon at night.No effect
(Norplac, 75 ug)
Dose: 1 t/ d
It has higher affinity for dopamine receptors: tumors resistant to
bromocriptine have responded to this drug (Speroff,1999)
(Dostinex, 0.5 mg)
Ergotline derivative, Long lasting
Dose: 1-2 t/ W
Side effects: less than bromocriptine