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Galactorrhea Classification and external resources ICD-10 N64.3, O92.6 ICD-9 611.6, 676.6 DiseasesDB 6314 MeSH D005687 Galactorrhea or galactorrhoea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "nipple discharge." [1] Contents 1 Causes 2 Neonatal Milk 3 See also 4 References 5 External links // Causes It can be due to dysregulation of certain hormones or local causes such as excessive nipple stimulation. Hormonal causes most frequently associated with galactorrhea are hyperprolactinemia and thyroid conditions with elevated levels of TSH or TRH hormones. Lactation requires the presence of estrogen, progesterone and prolactin, and the evaluation of galactorrhoea includes eliciting a history for various medications or foods (methyldopa, opiates, antipsychotics, as well as licorice[citation needed]) and for behavioral causes (stress, and breast and chest wall stimulation), as well as evaluation for pregnancy, pituitary adenomas (with overproduction of prolactin or compression of the pituitary stalk), and hypothyroidism. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and infertility, which may be a diagnostic clue. Galactorrhoea may also be caused by hormonal imbalances owing to birth control pills. Galactorrhoea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine (trade name: Tagamet). Galactorrhoea can be also caused by anti-psychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Case reports suggest Proton Pump inhibitors have been shown to cause Galactorrhoea. Neonatal Milk Neonatal milk or witch's milk is milk secreted from the breasts of many newborn infants. It is caused by a combination of the effects of maternal hormones before birth, prolactin and growth hormone passed through breast feeding and the postnatal pituitary and thyroid hormone surge in the infant. Witch's milk is more likely to be secreted by infants born at full term, than by prematurely-born infants. Breast milk production occurs in about 5% of newborns and can persist for two months though palpable breast buds can persist into childhood.[2] There is no treatment necessary; unless redness, tenderness, or fever develop which may be a sign of mastitis and may require antibiotics.[3] Blood from the nipples is nearly always benign and associated with the normal growth of the ducts, rather than mastitis.[3] Removing the milk from the breasts can prolong milk production and is considered necessary in some cultures.[4] While breastfeeding may also contribute to prolonged milk production and breast enlargement temporary or permanent weaning is not recommended.[3] In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirits.[5] It was thought to be stolen from unwatched, sleeping infants. In other cultures milking the infant's breasts is supposed to contribute to shapely breasts in adulthood.[3] See also Galactagogue References ^ Ladewig, P., London, M., Davidson, M. (2006). Contemporary Maternal-Newborn Nursing Care (6th ed.). New Jersey: Pearson Education, Inc. ISBN 0131703927. ^ "'Witch's milk'. Galactorrhea in the newborn". http://archpedi.ama-assn.org/cgi/content/abstract/140/3/252. Retrieved 2008-03-09.  ^ a b c d "'Breast Problems". http://www.eapsa.org/parents/resources/breast_disorders.cfm. Retrieved 2009-01-05.  ^ "'A MALE INFANT WITH GYNECOMASTIA-GALACTORRHEA". http://download.journals.elsevierhealth.com/pdfs/journals/0022-3476/PIIS0022347605005822.pdf. Retrieved 2009-01-05.  ^ Potts, Malcolm (1999). Ever Since Adam and Eve: The Evolution of Human Sexuality. p. 145. ISBN 0521644046.  External links Look up galactorrhea in Wiktionary, the free dictionary. familydoctor.org has a good overview of galactorrhea. http://www.calgaryhealthregion.ca/breasthealth/common_breast_conditions/gynecomastia_male.htm MR images Galactorrhea and Pituitary tumors (microadenoma) v • d • e Disorders of breast (N60-N64, 610-611) Mastitis Puerperal mastitis (Breast engorgement) · Nonpuerperal mastitis (Subareolar abscess/Zuska's disease, Granulomatous mastitis) Other Benign mammary dysplasia (Duct ectasia of breast · Chronic cystic mastitis) · Galactorrhea · Mastodynia · nipple (Nipple discharge, Inverted nipple, Fissure of nipple) · Galactocele · Ptosis · Breast cyst · Breast lump · Fat necrosis of breast · Gynecomastia · Hypertrophy of breast M: BRE anat/phys noco/cong/tumr proc v • d • e Pathology of pregnancy, childbirth and the puerperium (O, 630-679) Pregnancy Pregnancy with abortive outcome Ectopic pregnancy (Abdominal pregnancy, Cervical pregnancy, Ovarian pregnancy, Interstitial pregnancy) · Hydatidiform mole · Miscarriage Oedema, proteinuria and hypertensive disorders Gestational hypertension (Pre-eclampsia, Eclampsia, HELLP syndrome) · Gestational diabetes Other, predominantly related to pregnancy Digestive system Hyperemesis gravidarum · Intrahepatic cholestasis of pregnancy · Acute fatty liver of pregnancy · Hepatitis E Integumentary system/ dermatoses of pregnancy PUPPP · Gestational pemphigoid Impetigo herpetiformis · Intrahepatic cholestasis of pregnancy · Linea nigra · Prurigo gestationis · Pruritic folliculitis of pregnancy · Striae gravidarum Nervous system Chorea gravidarum Blood Gestational thrombocytopenia · Pregnancy-induced hypercoagulability Maternal care related to the fetus and amniotic cavity amniotic fluid (Polyhydramnios, Oligohydramnios) · chorion/amnion (Chorioamnionitis, Chorionic hematoma, Premature rupture of membranes, Amniotic band syndrome, Monoamniotic twins) · placenta (Placenta praevia, Placental abruption, Monochorionic twins, Twin-to-twin transfusion syndrome, Circumvallate placenta) · Braxton Hicks contractions · Hemorrhage (Antepartum) Labor Preterm birth · Postmature birth · Cephalopelvic disproportion · Dystocia (Shoulder dystocia) · Fetal distress · Vasa praevia · Uterine rupture · Hemorrhage (Postpartum) · placenta (Placenta accreta) · Umbilical cord prolapse · Amniotic fluid embolism Puerperal Puerperal fever · Peripartum cardiomyopathy · Postpartum thyroiditis · Puerperal mastitis · Breastfeeding difficulties (Agalactia, Galactorrhea) · Postpartum depression · Diastasis symphysis pubis Other Maternal death M: OBS phys/devp mthr/fetu/infc, epon proc, drug(2A/G2C)