galactorrhea - a selection of milk from the breast that is not associated with breast-feeding a child breast milk.The intensity of the milk ejection can be different.Sometimes there are small spots on the laundry discharge, less milk secretion is quite significant.Galactorrhea may be single or double-sided.The vast majority of galaktorei seen in women of childbearing age.In men, this casuistry.Galactorrhea for life happens quite often, according to some sources, 20% of women.
In this article we will talk about what a galactorrhea, what are the causes of this phenomenon, what signs to look out for and how to treat this disease. Content
galaktorei To understand why, you need to know how the body is regulated by secretion of breast milk.
Milk stands under the influence of prolactin - a hormone produced in a special small part of the brain - the pituitary gland.Synthesis constantly suppressed prolactin special substance (dopamine) that produce other small parts of the brain - the hypothalamus.When breastfeeding stops the hypothalamus secrete a substance, and prolactin, as it were "relieved."It begins intensive milk production.
Milk also causes a reflex in response to the attachment of the child to her breast.After weaning slight discharge from the breasts normally can be stored for 5 months.
synthesis of prolactin increases thyroid hormone produced in the hypothalamus and activates the formation of thyroid hormones in the thyroid gland.
hypothalamus - a small area in the brain has a very complex structure and many functions.Its failure may result from trauma, inflammatory processes in the brain tumor.A frequent reason for the defeat of the hypothalamus can be neyrotuberkulez and sarcoidosis.
manifested defeat hypothalamic neuroendocrine various syndromes (violation of fat, water and salt metabolism, hypo- and hyperthyroidism, and others).
When hypothalamic disease it reduced production of dopamine, which normally inhibits the production of prolactin is constantly in the pituitary gland.Prolactin synthesis increased, which stimulates the secretion of breast milk in the mammary glands.
galaktorei Such a mechanism is marked with the so-called Chiari syndrome - Frommelya.In this case, the primary lesion of the hypothalamus.Increased secretion of pituitary prolactin inhibits the release of follicle stimulating hormone.As a result, there is no maturation of follicles in the ovary develops amenorrhea - a long period of absence of menstruation.
Typically Chiari syndrome - Frommelya patients complain of prolonged absence of menstruation and lactation.In addition, they suffer from headaches, insomnia, blurred vision, weight loss or obesity often - abnormal growth of body hair.
There is a pituitary tumor, leading to excessive production of prolactin in it - prolactinoma.It is a benign tumor, it rarely becomes malignant.Most often it occurs in women, and up to a third of all pituitary tumors.This so-called pituitary microadenomas.It is hormonally active, but does not cause compression of the nerve pathways.However, patients with pituitary microadenomas should be warned that in case of occurrence of visual impairment or frequent headaches, she sought medical attention.
excess prolactin accompanied by galactorrhea and amenorrhea, and infertility.Sometimes the symptoms of hyperandrogenism: acne, male pattern body hair.For hyperprolactinemia is characterized by osteoporosis, caused by the "washout" of calcium from bone.
Sometimes macroadenoma pituitary, where growing tumor pressing on the nerve path, passing near the pituitary gland.The result is blurred vision (visual field loss, double vision).There are headaches, depression.In women, symptoms of compression of the nerve pathways are rare, they are more common hormonal disorders.
Among other reasons hyperprolactinemia (a condition in which increased amounts of the hormone prolactin) associated with pituitary disorders, it may be noted Addison disease, acromegaly, pituitary - Cushing, craniopharyngioma, hypothyroidism, metastatic tumors (particularly, lung cancer and breast cancer).Multiple endocrine neoplasia syndrome, Nelson, application thyrotropin-releasing hormone and increase the concentration of prolactin in the blood.
Galactorrhea is characteristic of the so-called primary hypothyroidism - a state where, in spite of the increased stimulation of the thyroid hormone production it is reduced.Such stimulation of the thyroid gland by means of pituitary thyroid stimulating hormone (TSH).Increased secretion of TSH causes hyperprolactinemia and galactorrhea.Primary hypothyroidism is accompanied by relevant clinical symptoms: drowsiness, lethargy, swelling, hair loss and others.
Elevated TSH can cause hyperthyroidism and effects: weight loss, heart palpitations, ophthalmopathy.Hyperthyroidism is rarely accompanied by galactorrhea than hypothyroidism.
About a third of cases of polycystic ovary syndrome is accompanied by hyperprolactinemia.Hyperprolactinemia is a functional one and is a result of the weakening effect of dopamine on the pituitary gland.High prolactin levels in polycystic ovary syndrome leads to disruption of the formation of follicles, causing an imbalance cyclical hormone production by the ovaries.Increased estrogen production further enhances the synthesis of prolactin.Therefore, polycystic ovary syndrome may be accompanied by galactorrhea.
As the level of estrogen is associated with the development of galactorrhea estrogenprodutsiruyuschih adrenal tumors.
Men galaktoreyu can cause a deficiency of male sex hormones, particularly testosterone.In this state, an increase of mammary glands (gynecomastia), reduced potency.
Cirrhosis of the liver, and kidney failure are often accompanied by galactorrhea.In severe liver damage with the development of liver failure disrupted inactivation of hormones in the cells of the body.Blood hormone levels (in particular, the prolactin) increases.
In renal insufficiency slows down metabolic products of prolactin from the body.
should also mention the possibility of an ectopic (ie, not the pituitary) prolactin production.It can be synthesized by such tumors as bronchogenic sarcoma and hypernephroma.
Hyperprolactinemia can be side effects of various drugs.These include methyldopa, antidepressants, cimetidine, dopamine antagonists.Estrogens (including oral contraceptives), reserpine, opiates, sulpiride and verapamil may also cause an increase in blood levels of prolactin and galactorrhea.
This disease can cause herpes zoster, injuries and diseases of the spinal cord and peripheral nerves at the level of the thoracic spine.Mentions the possibility of the development of galactorrhea when too active stimulation of the nipples during sexual contact, breast self-examination, when wearing tight underwear.
galactorrhea characterized milky discharge from the nipple of the mammary glands, with one or two sides, often with pressure.Selections can simply dirty underwear or be quite abundant.The admixture of blood or discoloration of uncharacteristic for galactorrhea.
Galactorrhea is very often associated with amenorrhea (lack of menstruation).
In addition, symptoms of the underlying disease that caused galaktoreyu.
examines the patient, palpation of the mammary glands.Evaluated gynecological history (menstrual cycles, date of last menstrual period, the presence of amenorrhea, infertility and so on).Rule out pregnancy.
assess the function of the liver and kidneys to eliminate hepatic or renal failure, in particular, is assigned the biochemical analysis of blood.
blood tested for prolactin, if necessary, re-appointed study.
Half of women with galactorrhea prolactin levels are normal.This is due to intermittent, transient increase in levels of this hormone.Therefore, we recommend repeating tests for prolactin levels.
One-third of women with galactorrhea no menstrual disorders.
If there galaktorei coupled with the absence of menstruation in 1/3 of the cases the reason is the pituitary adenoma.If you suspect a pituitary adenoma is assigned consulting ophthalmologist (the definition of the fields of view) and a neurologist.Radiography sella.
most informative method of diagnosis of pituitary adenoma is a magnetic resonance imaging (MRI).
addition can be performed ultrasound of the abdomen and pelvic organs (liver, kidney, ovaries), to determine the level of estrogen, TSH, thyroid hormones.
galaktorei Treatment primarily involves treatment of the underlying disease (eg, correction of hypothyroidism).At the phenomena of osteoporosis (loss of bone mineral density) prescribe appropriate treatment and diet.
If the cause of galactorrhea is a pituitary adenoma, treatment is usually started with the so-called dopamine agonists - substances that act unidirectionally with dopamine and inhibits the synthesis of prolactin in the pituitary gland.These include bromocriptine, pergolide, cabergoline.
estrogen drugs administered under strict indications, as their use is associated with an increased risk of developing tumors.
With the ineffectiveness of treatment with dopamine agonists surgical treatment: removal of pituitary adenoma.
If, despite all the measures, there is no effect of treatment, the courses of radiotherapy.
Treatment galaktorei performed if a woman planning a pregnancy;in severe osteoporosis;With abundant galaktoree, causes discomfort to the patient.In some cases, spend just watching for the patient, including a re-determination of prolactin levels and control brain MRI.
galactorrhea, as we see, in some cases quite "harmless" disease, but also is a condition could be evidence of more serious disorders in the body, which is why it is necessary to diagnose and timely detect hormonal disorders in the body.In this case, cure the disease will be much easier.