| Prolactinoma (Pituitary Adenoma) | 
Galactorrhoea (bilateral, milky discharge)Menstrual irregularities (e.g., amenorrhea)InfertilityHeadaches and visual disturbances (due to tumour compression) | 
Serum Prolactin Levels: Elevated levels.MRI of the Brain: To detect pituitary adenoma.Visual Field Testing: To assess for bitemporal hemianopsia. | 
Dopamine Agonists: Medications like cabergoline or bromocriptine to reduce prolactin levels and shrink the tumour.Surgery: Trans sphenoidal surgery for large or unresponsive tumours.Radiation Therapy: Considered if the tumour is not fully resectable. | 
 | Hypothyroidism | 
GalactorrhoeaFatigueWeight gainCold intoleranceDry skin and hair loss | 
Serum TSH Levels: Elevated TSH with low free T4.Serum Prolactin Levels: May be mildly elevated. | 
Thyroid Hormone Replacement: Levothyroxine to normalize thyroid function and reduce prolactin levels. | 
 | Medications (e.g., Antipsychotics, Antidepressants) | 
GalactorrhoeaPossible menstrual irregularitiesSymptoms related to the underlying condition being treated (e.g., psychosis, depression) | 
Medication History: Review of current and recent medications.Serum Prolactin Levels: May be elevated due to drug effects. | 
Discontinuation or Switching: Discontinuing or switching the causative medication if possible.Dopamine Agonists: Considered if medication cannot be discontinued and symptoms are severe. | 
 | Chronic Kidney Disease (CKD) | 
GalactorrhoeaSigns of CKD (e.g., oedema, fatigue, nausea) | 
Serum Creatinine and BUN: Elevated levels indicate kidney dysfunction.Serum Prolactin Levels: May be elevated due to decreased clearance by the kidneys. | 
Management of CKD: Includes dialysis or kidney transplant in advanced cases.Prolactin Management: Dopamine agonists may be used if galactorrhea is symptomatic. | 
 | Idiopathic Galactorrhoea | 
Galactorrhoea without an identifiable causeNormal menstrual cyclesNo significant medical history | 
Diagnosis of Exclusion: All other causes are ruled out.Serum Prolactin Levels: May be mildly elevated or normal. | 
Observation: Regular monitoring if asymptomatic and no underlying cause is identified.Dopamine Agonists: Used if symptoms are bothersome. |