Unexpected Galactorrhea in 34-Year-Old Female Seven Years Post-Lactation

Case at a Glance

A 34-year-old female presents with spontaneous lactation and nipple discomfort occurring seven years after cessation of breastfeeding, with no possibility of pregnancy due to prior hysterectomy.

Patient's Story

The patient, a 34-year-old female with a history of hysterectomy in November 2020 for uterine prolapse, presented with a 2-3 week history of severe nipple itching and pain. She described the sensation as an intense, unreachable itch that prompted aggressive rubbing of the affected area. During one such episode, she noticed milk-like discharge from her nipples. The discharge became continuous, requiring the use of breast pads similar to her experience during active lactation approximately 8 years prior. She had ceased breastfeeding 7 years ago and reported no current medications. Due to her hysterectomy, pregnancy was ruled out as a cause. The patient noted awareness of ovulatory cycles and hormonal fluctuations despite amenorrhea.

Initial Assessment

Physical examination revealed active galactorrhea with milk-like discharge from both nipples. The patient appeared otherwise well with no palpable breast masses or lymphadenopathy noted. Vital signs were within normal limits.

The Diagnostic Journey

Given the presentation of galactorrhea in a non-pregnant, non-lactating woman, a comprehensive evaluation was initiated. The differential diagnosis included prolactinoma, medication-induced galactorrhea, hypothyroidism, and other endocrine disorders. Laboratory workup was planned including serum prolactin levels, thyroid function tests, and comprehensive metabolic panel.

Final Diagnosis

Pending laboratory results and further imaging studies to determine the underlying cause of pathological galactorrhea.

Treatment Plan

Immediate referral to primary care physician for comprehensive evaluation and laboratory studies. Patient counseled on the importance of prompt medical attention given the various potential underlying causes requiring treatment.

Outcome and Follow-up

Patient scheduled appointment with primary care physician for same-week evaluation. Advised to continue monitoring discharge and report any changes in symptoms. Follow-up pending laboratory results and potential endocrinology referral based on findings.