Male Galactorrhea - An Insight

Introduction:

In males, galactorrhea mostly occurs due to overstimulation of breast nipples, drug abuse, and the development of pituitary tumors due to a diseased condition. Other factors can also lead to galactorrhea, like psychosocial stress, family history of thyroid disorder, or multiple endocrine neoplasia type I. Around 30 percent of patients with endocrine dysfunction face pituitary tumors and hypersecretion of prolactin hormone.

How Does Male Galactorrhea Differ From Female Galactorrhea?

• In Females: Galactorrhea is a condition where breast milk is induced. Usually, the lactation process occurs when a woman gives birth to a child. But galactorrhea is an inappropriate lactation where lactation occurs apart from post-delivery time. This abnormal condition affects almost 20 to 25 percent of women. The primary cause for such an abnormal lactating phase is due to hormonal imbalances like high prolactin or progesterone levels in the body, stress, suckling, sleep, high sexual activity, and medications. The presence of dopamine controls the excessive action of the prolactin hormone.

• In Males: This is caused primarily due to overstimulation of nipples along with hormonal variations. Galactorrhea is a self-limited condition that does not require any treatment. Knowing the cause is of prime importance.

What Are the Causes of Galactorrhea in Males?

Galactorrhea in males is due to various factors, such as:

• Drug-Induced: Various hormonal tablets like anabolic steroids cause gynecomastia.

• Pituitary Tumors: Malignant conditions where tumors develop, like craniopharyngioma, germinoma, and meningioma, can cause galactorrhea in males.

• Hypothalamic and Pituitary Lesions: Various pathological conditions like the hypothalamus and infundibular lesions can lead to abnormal prolactin secretion and cause male galactorrhea. Certain pituitary lesions like prolactinoma, acromegaly, and other lesions are equally responsible for such dysfunctions.

• Infiltrative Disorders: Diseases of the heart such as histiocytosis, sarcoidosis, and others can cause galactorrhea in males.

• Neurogenic Stimulation: Frequent nerve stimulation can lead to carrying wrong signals to the brain. This will eventually turn on the secretion responsible for milk secretion, like the hypothalamic prolactin inhibitory factor.

• Thyroid Disorders: Systemic diseases like low thyroid function or hypothyroidism can trigger the condition.

• Chronic Renal Failure: Renal insufficiency due to drug abuse can cause this condition.

• Hormonal Imbalance: Testosterone is responsible for developing male secondary sexual characteristics. The insufficiency of testosterone can lead to galactorrhea.

• Physiological Stimulation: It occurs in cases where the nipples are excited, or breasts are manipulated and can cause galactorrhea in males.

• Lesions of the Chest Wall: Conditions arising due to other secondary factors like breast surgery involving the chest wall, burns, herpes zoster virus infections, spinal cord injury, and other trauma caused can lead to the development of galactorrhea.

There are other unknown causes of developing male galactorrhea, which is named idiopathic hyperprolactinemia. Other causes include medication-induced hyperprolactinemia and normoprolactinemic galactorrhea.

What Are the Other Associated Signs of Galactorrhea in Males?

Apart from nipple discharge from both breasts, the patient might observe any below-listed signs, such as:

• Visual impairment.

• Inflammation of breast tissue.

• Swelling of the optic nerve (papilledema) due to over-exertion of pressure.

• Damage of nerve cells.

• Formation of swelling in neck or goiter.

• Dry skin.

• Shaking of hands.

• Headaches.

• Increased and decreased urination.

• Infertility.

• Fatigue.

• Intolerance to cold.

• Nervousness.

• Restlessness.

• Increased sweating.

• Seizures.

• Temperature intolerance.

• Mood swings.

• Appetite swings.

• Bulging of eyes as seen in cases with high thyroid.

What Are the Other Conditions Which Mimic the Symptoms of Galactorrhea?

Most pathological conditions carry similar signs and symptoms. So is galactorrhea. This rare condition occurs in men and can confuse the healthcare worker. Some of the similar differential diagnoses are as follows:

• Pituitary adenomas.

• Hypothyroidism.

• Neurological disorders.

• Chest wall irritation.

• Breast stimulation.

• Other physiological causes.

Can Galactorrhea Be Corrected?

Yes, galactorrhea can be corrected. But the treatment becomes challenging in some extreme cases where the hypothalamus, pituitary, and pineal glands have malignant tumor growth, which is beyond resectable. Depending upon the severity, the outcome is determined. Different treatment options available are as follows:

• In patients with high prolactin levels or hyperprolactinemic disorders where the prolactin level is greater than 200 ng per mL (200 mcg per L), drugs like Dopamine agonists are given.

• In patients with fertility disorders, drug-like Bromocriptine is given. This drug is preferred in cases with hyperprolactinemia-induced anovulatory infertility. Other drugs are available in the market, like Cabergoline (0.25 milligrams), which can be taken for five days. However, this drug is more expensive.

• In extreme cases, surgery can be performed where pituitary glands are hyperactive. The normal function of the body is regained by giving hormonal tablets.

• In cases of tumor development like prolactinomas, radiation therapy is done to arrest the tumor growth. Usually, the prognosis for prolactinomas is good and does not grow beyond a particular growth.

• Patients with thyroid dysfunction should be treated with thyroid hormone replacement therapy.

• Any drug which is causing this condition should be stopped and should be replaced with alternative agents.

What Are the Tests Available to Detect Galactorrhea in Males?

This condition can be confusing and may require multiple tests at a time to distinguish the abnormality. Some of the commonly conducted examinations are as follows.

• Physical Examination: The breasts should be examined for any abnormal signs of nodules and discharge. Usually, galactorrhea occurs bilaterally on both breasts.

• Prolactin Test: Blood tests are conducted to evaluate the measure of prolactin.

• Renal Test: Medications like steroids can lead to galactorrhea. As a result, the renal system shuts down and causes chronic renal failure. Therefore it is very important to check kidney function.

• Thyroid Test: The level of thyroid hormones must be evaluated. Patients with macroprolactinomas are evaluated for hypopituitarism.

• Magnetic Resonance Imaging: A brain MRI scan is done to check the function of hormones, the hypothalamus, and pituitary glands. The MRI of the pituitary fossa with the help of a chemical called gadolinium is conducted. This helps capture a more defined image of the structure and its function.

• Computed Tomography (CT): This test is unreliable for detecting small or large lesions, which are denser and makes it difficult to obtain contrast imaging of the structure.

• Bone Densitometry: This test is done in patients with hyperprolactinemia with high levels of prolactin and vitamin D hydroxylation. This can lead to osteoporosis or osteopenia in both males and females.

Galactorrhea can also be evaluated based on the microscopic study of the discharge. This helps in identifying the presence of fat globules.

Conclusion:

First of all, galactorrhea should be treated based on its cause. Treatment of the condition depends on its anatomic relevance, importance, and other commonly observed patterns. The habit of self-manipulation of the breasts and nipples should be strictly stopped. The condition resolves on its own once the habit is ceased. Lab investigations should only proceed after a thorough physical examination and detailed patient case history.