MRI 6 months after surgery showed no evidence of tumor. The patient is currently taking cabergoline and levothyroxine sodium. Discussion Galactorrhea is often encountered in the primary care setting. Although fat droplets should be present on microscopic evaluation for breast secretion to be considered milk, it is not necessary to actually see the discharge before initiating workup. Even minute breast discharge can be significant.
Prolactin is a stress hormone that is released episodically throughout the day.
Circulating levels may be increased by breast stimulation or examination, vigorous exercise, food ingestion, or sleep. Once drug ingestion and physiologic elevations of prolactin have been ruled out, a fasting, early morning serum prolactin level should be obtained. If it is elevated, the test should be repeated for confirmation, and a highly sensitive serum TSH test should be obtained to rule out hypothyroidism. The prolactin level at which radiographic surveillance is begun has been extensively debated. Although it is true that most prolactinomas are associated with high prolactin levels, other, more serious threats can be associated with disruption of synthesis or delivery from the tuberoinfundibular dopamine axis.