galactorrhea - is abnormal secretion of the mammary glands of milk or colostrum.This process often is bilateral in nature and is not related to childbirth and lactation.Galactorrhea diagnosed in 1 - 4% of the women, of whom 33% have at least one birth.The low incidence is likely to be explained by the fact that galactorrhea is sometimes transient (short-term) the nature and / or does not give women a serious inconvenience, especially if the discharge from the nipple has no independent nature.
physiological formation of milk in the mammary glands is called lactation.Milk is produced in glandular structures of the breast and is governed by a whole group of hormones:
• Growth Hormone - HGH;
• thyroxine - thyroid hormone;
• Cortisol is produced in the adrenal glands;
• pancreatic hormone - insulin;
• ovarian estrogen;
• And finally, the most "influential" in the process of secretion is milk hormone prolactin.It is synthesized by cells of the pituitary gland in a cyclic mode
prolactin increases from the first days of pregnancy and before delivery is maximized in this period, expectant mother first appear milky discharge from the breast - colostrum.Breastfeeding stimulates the production of prolactin.After the end of feeding performance prolactin returned to normal.
galactorrhea in pregnant and breast-feeding has the character of physiological lactation.Galactorea considered pathological if it occurs in a non-pregnant woman, or if it does not disappear after a year after the end of breastfeeding.
High levels of prolactin in the blood leads to the appearance galaktorei, but is not always the only reason for it.
Galactorrhea is not an independent disease, and establishes the state of the mammary glands.Some women diagnosed galactorea has no clinical significance.However, in some cases, galactorrhea syndrome includes several other pathological symptoms.Particular attention should be given combination galaktorei violations of the normal menstrual cycle, 80% of patients found galactorrhea and amenorrhea or galactorrhea and oligomenorrhea.
galactorrhea, unrelated to pregnancy and lactation has a very wide range of causes and requires detailed diagnosis.
Not every woman can not determine the cause of galactorrhea.If the examination of patients the cause hypersecretion of mammary glands is not installed, talk about idiopathic (functional) galaktoree.Rather, the presence of these patients galactorrhea associated with increased susceptibility to breast prolactin even under normal content in the blood.
character of discharge from the breast, and their number is not related to the reason for their appearance.
The formation of milk is difficult and multi-stage, it occurs with the participation of pituitary hormones, ovarian, thyroid and pancreas, the central nervous system is regulated.Thus, galaktoreyu can provoke disturbances arising at any stage of the process.
An increase in prolactin levels 50 - 80% of patients had galactorrhea.
The most frequent causes of galactorrhea include:
- a malfunction of the pituitary gland or tumor (usually - prolactinoma);
- Violation of the hypothalamus;
- Some medications (antihypertensives, and antiemetics, antidepressants, tranquilizers), including hormonal contraceptives;
- dysfunction of the thyroid gland (hyperthyroidism and hypothyroidism);
- Diseases of the adrenal gland;
- Some herbal medicines are natural estrogen;
- Polycystic ovary syndrome;
- Serious kidney damage and liver;
- Traumatic injuries to the breast (eg, during surgery) or deep burns of the chest;
- Mastitis (especially the severe forms);
- Excessive mechanical stimulation of mammary glands associated with wearing tight underwear, skin rash, increased sexual activity and other similar factors;
- The negative impact of stressful situations.
Among the reasons listed above, the most "popular" is a pituitary prolactinoma - a benign hormone-dependent tumors, stimulating excessive production of prolactin.
galaktorei incidence in healthy women throughout life varies from 2-20%, and is not associated with severe pathological causes.
In order to establish the cause of galactorrhea and determine whether its treatment, should see a specialist.
Symptoms and signs galaktorei
main (and only) a sign of galactorrhea - milky discharge from the breast.In appearance at the secret galaktoree not always exactly like milk and can range from translucent to milky white.Since the composition includes water, milk fat emulsion, as well as 100 other components, any deviation of quantitative changes in the composition of secretions and appearance.Discharge from the breast should not be sukrovichnymi or bloody, discharge of a color indicates the serious pathological processes and require additional emergency survey.
majority of patients indicate bilateral galactorrhea.Complaints about the allocation of milk from only one breast can indicate either a serious disease process, and are non-dangerous symptom.Abundant spontaneous discharge from one breast ("stain underwear" and "follow their own accord") can be caused by a benign pituitary tumor (prolactinoma), and a small-sided allocation of serous secretion observed in a significant proportion of healthy nulliparous women.
galactorrhea may be permanent and non-permanent.Spontaneous galactorea makes women see a specialist.At the reception, they complain about the spontaneous outflow of milk (one or two-way), leaving marks on the sheets and causing irritation to the skin of the mammary glands.
If galactorea appears only when pressing on the breast cancer and does not bother the woman, she is a very rare occasion to refer to the doctor and are diagnosed by chance.
If galactorrhea associated with other symptoms of anxiety, it becomes a sign of serious disorders in the body.Menstrual disorders exacerbate syndrome galactorrhea and point to abnormal hormonal abnormalities, namely overproduction of prolactin.Sometimes galactorrhea and amenorrhea develop simultaneously.Women with infertility often note the presence of galactorrhea.
galactorrhea in normal prolactin has no distinctive clinical features.
rare and poorly understood syndrome is primary hypothyroidism (hypothyroidism), in which on the background of hypothyroidism develop galactorrhea and amenorrhea.
as monosimptoma galactorea has no clinical significance, but its combination with other disorders (especially hormonal) may indicate the presence of serious diseases.
disturbing symptoms that accompany galaktoreyu are frequent severe headaches, blurred vision, pathological changes in the menstrual cycle, amenorrhea, or infertility.
To diagnose galaktoreyu enough to conduct an overall examination of the patient and identify the presence of discharge (single or double) of the breast.If it looks like a no colostrum or milk, it can be confused with separable from other (non-dairy) gland ducts opening on the nipple.Therefore, when viewed produce fence material (secret glands) for further laboratory analysis.At external examination of mammary glands excluded traumatic injury to the skin (including piercings), irritation or rash.
During the conversation with the patient clarifies important diagnostic factors:
- circumstances provoked galaktoreyu.Often breast allocation of a temporary nature and are alone.Galactorrhea may occur after abortion or after taking certain drugs.In such cases, the diagnosis galactorrhea requires immediate intervention;
- How long discharge from the breast, they appear spontaneously or only with manual removal.If the number and amount of secretions tend to increase, galactorrhea may be associated with the presence of a serious disease;
- Menstrual irregularities and / or infertility in combination with galactorrhea constitute a change in the normal hormonal regulation of the body of the patient and require further investigation;
- The presence of extragenital diseases.Some endocrine disorders, kidney or liver failure provoked galaktoreyu;
- Complaints patient with galactorrhea intensive headaches and visual disturbances that suggest the presence of a benign tumor of the pituitary gland.
detected by palpation (palpation) painful seals in the mammary glands (especially if the patient indicates their relationship to the menstrual cycle) suggests the presence of mastitis.
often diagnosed galactorrhea associated with higher levels of prolactin, 50-80% of patients with elevated levels of prolactin in the blood have galaktoreyu.Determining the level of prolactin in the blood is an important diagnostic criterion.Blood sampling is performed on day 5-8 of the cycle.
Prolactin is produced in the body cycle, his figures are the daily fluctuations and depend on some external and internal factors (eg, hypothermia or stress), so galactorea under normal prolactin should not be ignored.
Laboratory diagnosis, in addition to determination of prolactin, includes determining the level of thyroid hormone (TSH) and sex steroids (FSH, LH, etc.) in the blood.
examination by related professionals (including laboratory) in the presence of extragenital pathology is necessary to clarify the nature and causes of galactorrhea.Conclusions neurologist, endocrinologist and an ophthalmologist, in some cases, help to clarify the causes of galactorrhea and determine the choice of therapeutic measures.
instrumental studies at galaktoree include:
- mammography and breast ultrasound.Reveals the presence of mastitis and / or expansion of the milk ducts;
- Computed tomography (CT) scan of the brain for the diagnosis of benign tumors;
- pelvic ultrasound.Hormonal galaktorei confirm the origin of the detected structural abnormalities in the ovaries (polycystic especially).
independent significance as a disease has not galactorrhea and considered as part of symptoms of other diseases.Therefore, treatment of galactorrhea is to eliminate its causes.
dominant direction of drug therapy are reduction of prolactin levels and the removal of hormonal disorders.To reduce the level of prolactin in blood applied bromocriptine Parlodel, Pergolide and their analogs.
In patients with infertility and / or other gynecological diseases, galactorea disappears against the background eliminating ovarian hormonal dysfunction.
In rare cases, the presence of a pituitary tumor progression of hyperprolactinemia can not prevent conservative methods, and performed surgery.
galaktorei on the background of diseases of the thyroid gland or the adrenal gland are treated together with endocrinologists.Patients with idiopathic galactorrhea are subject to monitoring.