Nipple discharge. I need to conduct.

Galactorrhea is lactation in men or in women who are not breastfeeding. It is generally due to a prolactin-secreting pituitary adenoma.

Diagnosis: Prolactin levels | Thyroxine (T4) and TSH levels | CT or MRI

Asymptomatic patients who have prolactin levels < 100 ng/mL and normal CT or MRI results or who have only microadenomas can probably be observed; serum prolactin often normalizes within years. Indications for treatment in women include the desire for pregnancy, amenorrhea or significant oligomenorrhea (because of the risk of osteoporosis), hirsutism, low libido, and troublesome galactorrhea. Indications in men include hypogonadism (because of the risk of osteoporosis), erectile dysfunction, low libido, and troublesome infertility. The initial treatment is usually a dopamine agonist such as bromocriptine (1.25 to 5 mg po bid) or the longer-acting cabergoline (0.25 to 1.0 mg po once/wk or twice/wk). Cabergoline is the treatment of choice because it appears to be more easily tolerated and more potent than bromocriptine. Patients with macroadenomas generally should be treated with dopamine agonists or surgically but only after thorough testing of pituitary function and evaluation for radiation therapy. Dopamine agonists are usually the initial treatment of choice and usually shrink the tumor.