galactorrhea
Introduction
Introduction to galactorrhea Galitisrhea is a phenomenon of breast self-overflow in women who have not had a puerperium or stopped breastfeeding for half a year. It is characterized by lactation and amenorrhea. It is also known as amynorrhea-galactorrheasyndrome, milk leakage, and abnormal milk secretion. Syndrome, etc., is a pathological lactation during non-pregnancy. There are three cases depending on the subject: Chiari-Frommel syndrome (Mendel nomenclature, 1946), the patient is characterized by postpartum or post-weaning onset; Argone-Castillo syndrome (Argonz nomenclature, 1953) has a history that is not related to pregnancy. Forbes-Albright syndrome (Forbes, 1951), the diarrhea of the affected person with pituitary tumors, the three pathological conditions are different, but all have the pathological features of hypothalamic-pituitary imbalance. basic knowledge Sickness ratio: 0.5% Susceptible people: women Mode of infection: non-infectious Complications: infertility, headache
Cause
Cause of galactorrhea
Tumors in the hypothalamus and nearby (20%):
Such as craniopharyngioma, sarcoidosis, cancer metastasis, lymphoma, histiocytosis and pituitary stalk cutting, oppression or stimulation of the hypothalamus, reducing the secretion of prolactin inhibitor (PIF) or increased PRL secretion, or compression of the pituitary The handle affects the portal blood supply, PIF can not reach the pituitary, and the secretion of pituitary PRL increases.
Pituitary lesions (15%):
In particular, adenomas secreting PRL are more common. Some patients with pituitary adenomas have no lactation and PRL is increased, that is, Frobes-Albright syndrome occurs. Patients with galactorrhea are often low in gonadotropins and have low ovarian function. Some patients are accompanied by Acromegaly and thyroid function are often within the normal range. In addition, some so-called "empty sella" patients are accompanied by lactation and hyperprolactinemia.
Thyroid and other endocrine gland disorders or lesions (18%):
For example, patients with primary hypothyroidism are often accompanied by increased prolactin. Most patients with galactorrhea have a conspicuous enlargement of the sella and are often misdiagnosed as pituitary tumors. Therefore, all patients with galactorrhea should pay attention to the thyroid gland and, in addition, secrete estrogen. Ovarian or adrenal adenoma may inhibit hypothalamic function through an excess of estrogen, causing galactorrhea.
Effects of hormonal drugs (15%):
Oral contraceptives may sometimes have galactorrhea. Oral contraceptives contain estrogen and progesterone. The presence of galactorrhea may be related to the inhibition of the hypothalamus by estrogen or progesterone.
General drug effects (15%):
Long-term use of rifampicin (reserpine) or chlorpromazine, metoclopramide (metoclopramide), sulpiride, morphine, etc. are also sometimes galactorrhea, these are drugs that impede the role of PIF in the hypothalamus, lifting The role of PIF increases the secretion of pituitary PRL.
Chest wall lesions (10%):
Chest wall damage (including trauma, surgery, burns or herpes zoster) can also cause an increase in PRL secretion by reflection.
Other factors (5%):
Other non-endocrine gland tumors are associated with "atopic" prolactin secretion syndrome, such as bronchial or renal cancer.
Prevention
Breast diarrhea prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases. In particular, women should pay attention to breast hygiene and maintenance, should choose the right underwear, wear properly; in addition, women should also do regular breast examination, and strive to find the disease early in the disease and treat it as soon as possible.
Complication
Chest complication Complications, infertility, headache
1. Cystic hyperplasia of the breast: In some patients, the female nipple discharge is yellow-green, brown, bloody or colorless, and the presence of tumor-free cells in the test is checked.
2, papillary tumor in the duct: 75% of the tumor occurs in the vicinity of the nipple, the tumor is small, with pedicle and fluff, and there are many thin blood vessels, it is easy to bleed. Tumor cells can be found in the test and examination. Sometimes the patient carefully touches the breast, and it can be found that there are large chunks of cherries under the areola, which are soft, smooth and active.
Symptom
Symptoms of galactorrhea common symptoms amenorrhea due to amenorrhea
Ulcer
More manifested as double nipple galactorrhea, milk is white, light yellow, pressing double breasts and nipple visible spontaneous discharge, the degree of discharge is different, can be sprayed or squeezed a small amount, from the chemical composition, between colostrum and Between milk, sometimes with colostrum, a small number of lactation lasts for a long time, milk can be mixed with blood, may be caused by intraluminal papilloma.
2. Amenorrhea
Often secondary amenorrhea, the degree of amenorrhea is also different, manifested as rare menstruation or long-term amenorrhea, long menstrual period, genital atrophy, uterus significantly reduced, short menstrual period, no significant changes in the vulva, normal or reduced uterus.
3. Other
Some patients may present symptoms such as infertility, headache, limb hypertrophy, and visual impairment.
Examine
Breast diarrhea examination
1, blood prolactin determination: the use of immunoassay to determine the level of prolactin in the blood, most patients with elevated levels of prolactin in the blood lead to dysfunction of the thalamus-pituitary-ovarian axis, so that pituitary gonadotropin function is inhibited, PSH, LH secretion Reduced, while the secretion of ovarian steroid hormone E2 is also significantly reduced, resulting in menstrual closure, milk spillage, if the blood prolactin continues to rise, often suggesting the possibility of pituitary tumors.
2, other hormone determination FSH: LH value is slightly lower or equal to the normal level of normal follicle; E2 determination is lower than or equal to the ovulation period; T3, T4 is lower than normal; and TSH is higher than the normal range.
3, excitement or inhibition test: mainly to understand the reserve power of hypothalamic-pituitary function, the increase in PRL is obvious, indicating that the hypothalamic-pituitary dysfunction is more likely.
(1) Thyroid-releasing hormone test: intravenous injection of TRH 500g, blood PRL level after 15min, women increased to 40ng/ml or more, 1 to 2 times higher than the baseline value, but the PRL release effect of TRH in pituitary tumor patients is lower than normal .
(2) chlorpromazine stimulation test: after intramuscular injection of chlorpromazine 25 ~ 50mg, prolactin increased 1 times in 60 ~ 90min, and continued for 3h, the test results positive indicates hyperprolactinemia, caused by dysfunction, if Caused by pituitary tumors, it is rarely affected.
(3) levodopa inhibition test: oral levodopa 500mg, blood prolactin levels decreased significantly to > 4g / ml within 2 ~ 3h, if there is no significant decline, the possibility of pituitary tumors is large.
4. Skull X-ray: If necessary, a saddle tomography, gas cerebral angiography, computed tomography (CT) or magnetic resonance imaging (MRI) may be performed to detect small tumors of the pituitary.
5. Fundus and visual field examination: to understand the changes in the fundus or visual field caused by tumor compression.
Diagnosis
Diagnosis of breast diarrhea
diagnosis
1. Medical history: pay attention to the onset process, the patient is postpartum or after weaning, or women who have not been pregnant, should also pay attention to whether or not to take related drugs, such as chlorpromazine, risperidone or oral contraceptives.
2. Physical examination: pay attention to breast, chest wall lesions, with or without acromegaly or Cushing's syndrome, pay attention to the presence or absence of pelvic mass or genital atrophy.
3. Auxiliary examination: Determination of thyroid-releasing hormone, pituitary function test, skull X-ray, CT scan, etc., obvious cause of galactorrhea.
Differential diagnosis
The disease must be differentiated from random lactation amenorrhea and lactating uterine atrophy caused by nipple stimulation. In addition, pituitary tumors may have the same performance as Chiari-Frommel syndrome and should be examined. The disease can continue until menopause.
