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class="vector-toc-numb">2.2</span> <span>Prolactin</span> </div> </a> <ul id="toc-Prolactin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Medications</span> </div> </a> <ul id="toc-Medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prolactinoma" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Prolactinoma"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Prolactinoma</span> </div> </a> <ul id="toc-Prolactinoma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Thyrotoxicosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Thyrotoxicosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Thyrotoxicosis</span> </div> </a> <ul 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vector-toc-level-2"> <a class="vector-toc-link" href="#Giant_mastauxe"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Giant mastauxe</span> </div> </a> <ul id="toc-Giant_mastauxe-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Case_studies_and_reports" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Case_studies_and_reports"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Case studies and reports</span> </div> </a> <button aria-controls="toc-Case_studies_and_reports-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Case studies and reports subsection</span> </button> <ul id="toc-Case_studies_and_reports-sublist" class="vector-toc-list"> <li id="toc-Hormone" class="vector-toc-list-item vector-toc-level-2"> <a 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class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span 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mw-list-item"><a href="https://ca.wikipedia.org/wiki/Llet_de_bruixa" title="Llet de bruixa – Catalan" lang="ca" hreflang="ca" data-title="Llet de bruixa" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Heksem%C3%A6lk" title="Heksemælk – Danish" lang="da" hreflang="da" data-title="Heksemælk" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Hexenmilch" title="Hexenmilch – German" lang="de" hreflang="de" data-title="Hexenmilch" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Leche_de_bruja" title="Leche de bruja – Spanish" lang="es" hreflang="es" data-title="Leche de bruja" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Lait_de_sorci%C3%A8re" title="Lait de sorcière – French" lang="fr" hreflang="fr" data-title="Lait de sorcière" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Vje%C5%A1ti%C4%8Dje_mlijeko" title="Vještičje mlijeko – Croatian" lang="hr" hreflang="hr" data-title="Vještičje mlijeko" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%B5%E0%B4%BF%E0%B4%9A%E0%B5%8D%E0%B4%9A%E0%B5%8D%E0%B4%B8%E0%B5%8D_%E0%B4%AE%E0%B4%BF%E0%B5%BD%E0%B4%95%E0%B5%8D%E0%B4%95%E0%B5%8D" title="വിച്ച്സ് മിൽക്ക് – Malayalam" lang="ml" hreflang="ml" data-title="വിച്ച്സ് മിൽക്ക്" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Heksenmelk_(baby)" title="Heksenmelk (baby) – Dutch" lang="nl" hreflang="nl" data-title="Heksenmelk (baby)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E9%AD%94%E4%B9%B3" title="魔乳 – Japanese" lang="ja" hreflang="ja" data-title="魔乳" data-language-autonym="日本語" data-language-local-name="Japanese" 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data-event-name="pinnable-header.vector-appearance.unpin">hide</button> </div> </div> </div> </nav> </div> </div> <div id="bodyContent" class="vector-body" aria-labelledby="firstHeading" data-mw-ve-target-container> <div class="vector-body-before-content"> <div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Milk secreted from the breasts of some newborn human infants of either sex</div> <p> <b>Witch's milk</b> or <b>neonatal milk</b> is <a href="/wiki/Milk" title="Milk">milk</a> secreted from the <a href="/wiki/Breast" title="Breast">breasts</a> of some newborn human <a href="/wiki/Infant" title="Infant">infants</a> of either sex.<sup id="cite_ref-Devidayal_2005_1-0" class="reference"><a href="#cite_note-Devidayal_2005-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Production of neonatal milk by infants usually resolves itself and does not require treatment unless it is caused by an underlying condition or medications.<sup id="cite_ref-:5_2-0" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It is thought to be caused by the exposure to an elevated level of estrogen to infants during pregnancy<sup id="cite_ref-:5_2-1" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> or decreased exposure of estrogen to infants after birth.<sup id="cite_ref-:10_3-0" class="reference"><a href="#cite_note-:10-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Its production also may be caused by certain medications.<sup id="cite_ref-Paturi_2009_4-0" class="reference"><a href="#cite_note-Paturi_2009-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The composition of neonatal milk is similar to maternal milk for most of their components except for fats and one type of antibody.<sup id="cite_ref-Yap_1980_6-0" class="reference"><a href="#cite_note-Yap_1980-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Neonatal milk production occurs in about 6% of newborns with age from 0 to 12 weeks. Within the age range, infants age 0 to 2 weeks were found to have the highest occurrence. Compared to those who did not have neonatal milk production, infants who did had larger breast nodules.<sup id="cite_ref-ama-assn_8-0" class="reference"><a href="#cite_note-ama-assn-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Pre-term infants under the <a href="/wiki/Gestational_age" title="Gestational age">gestational age</a> of 34 weeks did not secrete milk as observed in one study.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Complications such as mastitis and abscesses are associated with breast massage of the neonate's breast.<sup id="cite_ref-:11_10-0" class="reference"><a href="#cite_note-:11-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Squeezing of neonate's breast could also result in an infection.<sup id="cite_ref-:10_3-1" class="reference"><a href="#cite_note-:10-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Blood from the nipples is nearly always benign and frequently associated with <a href="/wiki/Duct_ectasia" class="mw-redirect" title="Duct ectasia">duct ectasia</a>; it should only be investigated when it is unilateral.<sup id="cite_ref-Weimann_2003_11-0" class="reference"><a href="#cite_note-Weimann_2003-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>The name witch's milk originates from ancient folklore<sup id="cite_ref-:14_12-0" class="reference"><a href="#cite_note-:14-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> and is associated with religious and cultural interpretations.<sup id="cite_ref-:0_13-0" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_14-0" class="reference"><a href="#cite_note-:1-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Lactation_physiology">Lactation physiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=1" title="Edit section: Lactation physiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The hormone <a href="/wiki/Prolactin" title="Prolactin">prolactin</a> has a key role in <a href="/wiki/Lactation" title="Lactation">lactation</a> and breast development in the human body and it is also a functional component of homeostasis.<sup id="cite_ref-:2_15-0" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> It has varying originations including the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system (CNS)</a>, the <a href="/wiki/Immune_system" title="Immune system">immune system</a>, <a href="/wiki/Mammary_gland" title="Mammary gland">mammary glands</a>, and <a href="/wiki/Uterus" title="Uterus">uterus</a>. Development and introduction of any of the following contributes to its production as well: <a href="/wiki/Thyrotropin-releasing_hormone" title="Thyrotropin-releasing hormone">thyrotropin releasing hormone (TRH)</a>, <a href="/wiki/Estrogen" title="Estrogen">estrogen</a>, and <a href="/wiki/Dopamine_antagonist" title="Dopamine antagonist">dopamine antagonists</a>.<sup id="cite_ref-:2_15-1" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>However, the <a href="/wiki/Pituitary_gland" title="Pituitary gland">pituitary gland</a> is a primary source for the synthesis and secretion of prolactin. Prolactin's primary functions are breast milk production and mammary gland development. Prolactin has a stimulating effect on alveoli within the mammary glands causing the production of milk that consists of <a href="/wiki/Lactose" title="Lactose">lactose</a>, <a href="/wiki/Casein" title="Casein">casein</a>, and lipids.<sup id="cite_ref-:2_15-2" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> The anterior region of the pituitary gland, more specifically, houses an increasingly abundant number of <a href="/wiki/Lactotrophs" class="mw-redirect" title="Lactotrophs">lactotrophs</a> (stimulated within the physiology of <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>) that synthesize prolactin for secretion. The rise of lactotroph proliferation is attributed to growing estrogen levels within a pregnant individual.<sup id="cite_ref-:3_16-0" class="reference"><a href="#cite_note-:3-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Connecting to the pituitary gland via the <a href="/wiki/Pituitary_stalk" title="Pituitary stalk">infundibular stalk</a>, is the <a href="/wiki/Hypothalamus" title="Hypothalamus">hypothalamus</a> of which is the primary regulator of prolactin production.<sup id="cite_ref-:2_15-3" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> The dopamine the hypothalamus releases has an inhibitory effect on lactotrophs, controlling its prolactin secretion.<sup id="cite_ref-:4_17-0" class="reference"><a href="#cite_note-:4-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> The serum levels of prolactin are typically low in males and non-lactating females, inhibiting possibility for breastmilk production. In the cases that the serum levels of prolactin do become high in these individuals, the phenomenon <a href="/wiki/Galactorrhea" title="Galactorrhea">galactorrhea</a> is to occur. </p> <div class="mw-heading mw-heading2"><h2 id="Witch's_milk_pathophysiology"><span id="Witch.27s_milk_pathophysiology"></span>Witch's milk pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=2" title="Edit section: Witch's milk pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Hyperprolactinemia">Hyperprolactinemia</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=3" title="Edit section: Hyperprolactinemia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Witch's milk, or neonatal <a href="/wiki/Galactorrhea" title="Galactorrhea">galactorrhea</a>, in newborns is primarily caused by <a href="/wiki/Hyperprolactinemia" class="mw-redirect" title="Hyperprolactinemia">hyperprolactinemia</a> - abnormally high level of prolactin hormone. Please note that galactorrhea and hyperprolactinemia physiologies are independent of one another.<sup id="cite_ref-:4_17-1" class="reference"><a href="#cite_note-:4-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> There are currently two different mechanisms described in literatures explaining the cause of hyperprolactinemia in neonates. One mechanism states that hyperprolactinemia in neonates results from the decline of maternally transferred estrogen after birth. Decreased estrogen increases production of prolactin which increases milk production.<sup id="cite_ref-:10_3-2" class="reference"><a href="#cite_note-:10-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The other mechanism states that hyperprolactinemia in neonates after birth results from their exposure to high maternally transferred estrogen level during pregnancy.<sup id="cite_ref-:5_2-2" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Prolactin">Prolactin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=4" title="Edit section: Prolactin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <a href="/wiki/Breastfeeding" title="Breastfeeding">breastfeeding</a>, pituitary hormone prolactin vary throughout pregnancy and in different lactation conditions.<sup id="cite_ref-Friesen_1973_18-0" class="reference"><a href="#cite_note-Friesen_1973-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Prolactin, produced by the pituitary gland, is essential for initiating and maintaining milk production. Its levels increase during pregnancy to prepare the breasts for milk production and remain high after childbirth to continue supporting breastfeeding. Issues related to abnormal lactation, such as inadequate milk supply or galactorrhea, an excessive milk flow not linked to childbirth, are also explored. Fluctuations in prolactin levels can significantly influence these problems. By analyzing prolactin levels in various lactation situations, insights are provided into how changes in prolactin affect milk production and overall lactation health. This emphasizes the importance of understanding prolactin's role for better diagnosis and management of lactation issues, offering valuable information for treating both normal and problematic lactation cases.<sup id="cite_ref-Friesen_1973_18-1" class="reference"><a href="#cite_note-Friesen_1973-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medications">Medications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=5" title="Edit section: Medications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Medications are a significant cause of hyperprolactinemia and galactorrhea. They can disrupt the normal regulation of prolactin by either inhibiting <a href="/wiki/Dopamine" title="Dopamine">dopamine</a>, which naturally suppresses prolactin secretion, or by directly stimulating the release of prolactin. <a href="/wiki/Opiates" class="mw-redirect" title="Opiates">Opiates</a> are among these medications. They can elevate prolactin levels by inhibiting dopamine release, reducing the dopamine-mediated suppression of prolactin, thus leading to increased prolactin levels and possibly causing galactorrhea. The use of opiates by mothers during pregnancy or breastfeeding can transfer these drugs to the infant, potentially leading to neonatal galactorrhea, also known as "witch's milk."<sup id="cite_ref-:7_19-0" class="reference"><a href="#cite_note-:7-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Prolactinoma">Prolactinoma</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=6" title="Edit section: Prolactinoma"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A tumor originating in the pituitary gland is one cause of galactorrhea.<sup id="cite_ref-:5_2-3" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This pituitary tumor, <a href="/wiki/Prolactinoma" title="Prolactinoma">prolactinoma</a>, results in an overproduction of prolactin, or <a href="/wiki/Hyperprolactinaemia" title="Hyperprolactinaemia">hyperprolactinemia</a>.<sup id="cite_ref-:5_2-4" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This type of cause is classified under organic hyperprolactinemia.<sup id="cite_ref-:3_16-1" class="reference"><a href="#cite_note-:3-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> In pregnancy, the lactotroph production increases through means of cellular proliferation of which gives rise to potential for neoplastic development.<sup id="cite_ref-:5_2-5" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This is especially true in cases where this proliferation becomes uncontrollable. In patients of varying ages who present with hyperprolactinemia, 12-70% of them have been diagnosed with prolactinoma.<sup id="cite_ref-:5_2-6" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Thyrotoxicosis">Thyrotoxicosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=7" title="Edit section: Thyrotoxicosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Changes in estrogen levels attributed to alterations in metabolism, for example, result in <a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">thyrotoxicosis</a> which also leads to galactorrhea.<sup id="cite_ref-:5_2-7" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This type of cause is classified under functional hyperprolactinemia.<sup id="cite_ref-:3_16-2" class="reference"><a href="#cite_note-:3-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> When estrogen levels rise in the placental-fetal circulation, breast enlargement in breastfed infants occurs temporarily but also has the potential to last longer in some cases.<sup id="cite_ref-:5_2-8" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Complications">Complications</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=8" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Witch's milk can last about 6 months then usually resolves on its own.<sup id="cite_ref-:9_20-0" class="reference"><a href="#cite_note-:9-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> However, the breast area may become red, tender, or swollen, which is an indication that an infectious complication may have risen.<sup id="cite_ref-:9_20-1" class="reference"><a href="#cite_note-:9-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> It was reported that the most common bacteria that causes these complications is <i><a href="/wiki/Staphylococcus_aureus" title="Staphylococcus aureus">Staphylococcus aureus</a>.</i><sup id="cite_ref-:9_20-2" class="reference"><a href="#cite_note-:9-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> This was shown in one study that out of 32 of the 36 participants was shown to have an infection in their breast due to <i>Staph. aureus.</i><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> It is believed that such infection occurs when bacteria from the skin enters into the breast.<sup id="cite_ref-:12_22-0" class="reference"><a href="#cite_note-:12-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The act of removal of the witch's milk by exploiting the neonatal's breast and breast tissue can allow bacteria to grow<sup id="cite_ref-:10_3-3" class="reference"><a href="#cite_note-:10-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> and cause the complications such as mastitis and breast abscesses.<sup id="cite_ref-:11_10-1" class="reference"><a href="#cite_note-:11-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> On the other hand, breast enlargement can occur due to hormone imbalances that occur before birth, such as mastauxe. This can lead to neonatal galactorrhea or witch's milk. </p> <div class="mw-heading mw-heading3"><h3 id="Mastitis">Mastitis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=9" title="Edit section: Mastitis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One problem that can arise from the infection of <i>Staphylococcus aureus</i> in the breast is mastitis. Among infants, mastitis occurs more frequently in full-term females<sup id="cite_ref-:10_3-4" class="reference"><a href="#cite_note-:10-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> and infants under the age of 5 weeks.<sup id="cite_ref-:12_22-1" class="reference"><a href="#cite_note-:12-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Additionally, Staphylococcus aureus causes about 85% of cases encounter.<sup id="cite_ref-:8_23-0" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> However, other bacteria such as gram-negative enteric bacteria, anaerobes, and Group B <i><a href="/wiki/Streptococcus" title="Streptococcus">Streptococcus</a></i> can be the cause of the neonatal mastitis.<sup id="cite_ref-:11_10-2" class="reference"><a href="#cite_note-:11-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The clinical presentation of mastitis can manifest has painful, swelling, and an abscess can form after 4 weeks. Mastitis can occur in one of the breast but in some cases it can occur in both breasts of the neonate. Treatment can be done by using an aggressive course of antibiotics if treated right away and upon diagnosis, which was shown to be 50% effective.<sup id="cite_ref-:8_23-1" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Surgical interventions for drainage and abscess removal may be required if infection progresses. Untreated mastitis can lead to further consequences such as <a href="/wiki/Cellulitis" title="Cellulitis">cellulitis</a>, <a href="/wiki/Fasciitis" title="Fasciitis">fasciitis</a>, and <a href="/wiki/Sepsis" title="Sepsis">sepsis</a>.<sup id="cite_ref-:12_22-2" class="reference"><a href="#cite_note-:12-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Giant_mastauxe">Giant mastauxe</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=10" title="Edit section: Giant mastauxe"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Mastauxe is derived from two Greek words '<a href="/wiki/Mastos" title="Mastos">mastos</a>' (breasts) and 'auxein' (increase in size). Mastauxe is breast enlargement that is characterized by the increase in diameter size of breast buds that is larger than 3cm. This phenomenon is not fully understood today but it is said to be caused by the transfer of maternal estrogens or the decrease of estrogens in the late stages of pregnancy. The differentiation between mastitis or breast abscess should be established by certain labs or test, such as <a href="/wiki/Ultrasonography" class="mw-redirect" title="Ultrasonography">ultrasonography</a> and laboratory findings. These laboratory findings include <a href="/wiki/White_blood_cell_count" class="mw-redirect" title="White blood cell count">white blood cell count</a> and <a href="/wiki/C-reactive_protein" title="C-reactive protein">C-reactive protein</a> levels. This condition resolves on its own through continuous observation and reassurance.<sup id="cite_ref-:13_24-0" class="reference"><a href="#cite_note-:13-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Case_studies_and_reports">Case studies and reports</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=11" title="Edit section: Case studies and reports"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Hormone">Hormone</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=12" title="Edit section: Hormone"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A 13-day old male infant with bilateral breast enlargement from birth accompanied with recent development of witch’s milk presents to the outpatient facility. Upon physical examination, the infant was found to have normal vitals such as heart rate and body temperature. In addition, blood tests, ultrasound, and physical examination found no evidence of complications such as breast abscess. Therefore, the patient was diagnosed with giant mastauxe. Breast enlargement and witch’s milk found in this patient was believed to be caused by either the exposure to estrogen during pregnancy or the reduced estrogen exposure postnatally. Neither the patient nor the mother took any medication that could contribute to the infant's breast development. Prior to their presentation to the outpatient facility, the mother did attempt chest manipulation trying to reduce the breast size.<sup id="cite_ref-:13_24-1" class="reference"><a href="#cite_note-:13-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=13" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A rare case of infant galactorrhea associated with maternal use of antidepressants is has been reported.<sup id="cite_ref-Gomes_2024_25-0" class="reference"><a href="#cite_note-Gomes_2024-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> A 3-month-old infant developed nipple lesions and milk production. Initially, the condition was thought to be an infection due to excessive handling. However, repeated episodes prompted further investigation by a mastologist, who suggested that the galactorrhea could be linked to the mother’s antidepressant medication, specifically sertraline and quetiapine. Although these medications are generally considered safe during breastfeeding, they can still affect the infant. This case highlights the importance of considering this rare but possible side effect when diagnosing persistent galactorrhea in infants. It underscores the need for thorough monitoring and assessment of potential drug impacts on infants, particularly when common explanations for symptoms do not apply.<sup id="cite_ref-Gomes_2024_25-1" class="reference"><a href="#cite_note-Gomes_2024-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Congenital_heart_failure">Congenital heart failure</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=14" title="Edit section: Congenital heart failure"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A 16-day old male infant was treated with congenital heart failure presented with bilateral breast enlargement and witch’s milk. After 3 weeks of heart failure treatment, although he did not show any improvement for heart failure, the breast returned to normal size and no witch’s milk was observed. Within the period of treatment, the infant’s prolactin level showed a trend with both decrease and increase ending with an elevated level. The estrogen level was lower at the end of the 3 week period compared to the beginning, but still remained at an elevated level. It was proposed that both high level of estrogen due to the decreased metabolism of estrogen resulted from heart failure and the high sensitivity of the infant’s breast toward estrogen contribute to the development of breast enlargement and high level of prolactin for witch’s milk.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cultural_interpretations">Cultural interpretations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=15" title="Edit section: Cultural interpretations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The term "witch's milk" comes from ancient folklore that stems from the 17th century belief that the fluid leaking from a newborn's nipple was a source of nourishment for witches' familiar spirits.<sup id="cite_ref-:14_12-1" class="reference"><a href="#cite_note-:14-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Across Europe, neonatal lactation was called "witch's milk", "Hexenmilch" and "lait de sorciere", and it was accused of being a potential source for witchcraft.<sup id="cite_ref-:0_13-1" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Some communities believed that women who has sold their souls to Satan in return for mystical powers would persecute babies by sucking their mammary glands and leaving "witches' marks".<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> This sinister association led to widespread fear and superstitions surrounding the condition of Galactorrhea. In an attempt to protect again this superstition, some family members would go to the extent of "milking" infants with this condition in order to prevent a witch coming to collect their milk.<sup id="cite_ref-:0_13-2" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> It was commonly thought to be stolen from unwatched, sleeping infants. This added more fear and anxiety which further intertwined the medical condition with supernatural fears. </p><p>There is also a religious interpretation behind the significance of witch's milk. In the 1500s in England, milk was symbolically linked with nurture and purity, and was particularly associated with the Virgin Mary.<sup id="cite_ref-:0_13-3" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> However, the symbolism behind milk might be different amongst different religions. For instance, in ancient Egyptian religion, milk was a sacrificial offering as a form of libation to gods and where resurrections are associated with the milk of goddesses.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Milk would often be used as a ritual offering in various other societies as well including Mesopotamia, Egypt, India, and Europe. In Egypt specifically, milk was rarely consumed by adults but as in the case of early Mesopotamia, was drunk only by children or used in religious ceremonies because of how scarce milk was.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> However, when the milk came out of so-called "unnatural" places, it was either seen as divine or satanic. </p><p>The cultural interpretations of witch's milk vary significantly across different cultures, influencing how parents address the condition when their child has galactorrhea. For instance, in India, there is an age-old practice in place where mothers would squeeze the swollen breasts of infants that contained witch's milk in an attempt to prevent the development of large breasts, which are considered inappropriate before the age of marriage.<sup id="cite_ref-:1_14-1" class="reference"><a href="#cite_note-:1-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> This practice, rooted in cultural beliefs and superstitions, contrasts with modern medical advice which strongly discourages such actions of squeezing the milk out of the breasts because it increases the risk of infections such as mastitis.<sup id="cite_ref-:11_10-3" class="reference"><a href="#cite_note-:11-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Similar practices have been observed in various cultures where traditional beliefs and medical knowledge intersect. This highlights why understanding the cultural nuances behind approaches to care is crucial for providing culturally sensitive healthcare and education to parents. Since so many cultures may have different customs when it comes to addressing galactorrhea, it is important to talk to the patient about the significance they place on "witch's milk". This will help dismantle clinical barriers that result from patient and provider interactions clouded by sociocultural differences. When these barriers are not identified, accepted, or understood, it can lead to mistrust, dissatisfaction, decreased adherence, and poorer health outcomes.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Making an effort to understand the cultural interpretations behind conditions such as galactorrhea can help bridge the gaps in care that many minority groups face when compared to their white counterparts considering that cultural competence from healthcare staff has been shown to improve general healthcare system quality.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Comparison_to_adolescent_galactorrhea">Comparison to adolescent galactorrhea</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=16" title="Edit section: Comparison to adolescent galactorrhea"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>"Witch's milk" and adolescent galactorrhea are both forms of abnormal milk production, but they differ significantly in terms of age group, causes, and management. Witch's milk occurs in newborns and is typically due to maternal hormones that cross the placenta during pregnancy. These hormones can stimulate the infant's mammary glands to produce milk, a condition that is relatively common, affecting about 5% of newborns.<sup id="cite_ref-Peña_2001_32-0" class="reference"><a href="#cite_note-Peña_2001-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Witch's milk is usually self-limiting and resolves within a few weeks as the maternal hormones dissipate from the infant's system. Parents are advised not to express the milk, as this can stimulate further production, and no specific treatment is generally required. </p><p>In contrast, adolescent galactorrhea occurs in teenagers and involves the production of milk in individuals who are not pregnant or breastfeeding. The causes of adolescent galactorrhea are varied and can include multiple factors.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> A common cause is hormonal imbalances, particularly high levels of prolactin, a hormone produced by the pituitary gland that regulates milk production.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Excessive prolactin can lead to milk production even when it’s not warranted. Certain medications can also play a role; for example, antipsychotics might disrupt dopamine regulation, resulting in elevated prolactin levels. Similarly, antidepressants and some antihypertensives can have comparable effects. </p><p>Disorders affecting the pituitary gland, such as prolactinomas (benign tumors that produce too much prolactin), are another potential cause. Hypothyroidism, characterized by an underactive thyroid gland, can also lead to higher prolactin levels and contribute to the condition.<sup id="cite_ref-:5_2-9" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Chronic kidney disease may affect the body's hormonal balance, potentially leading to elevated prolactin and galactorrhea.<sup id="cite_ref-:5_2-10" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> In some cases, no clear cause is identified, and the condition is labeled idiopathic. </p><p>Adolescent galactorrhea is less frequent than witch's milk, which usually occurs in newborns. However, it can signal an underlying medical issue that needs to be addressed. The condition may persist until the root cause is diagnosed and treated. To determine the cause, a comprehensive medical evaluation is needed, which could include blood tests, MRI scans to assess the pituitary gland, and a review of the patient’s medication history.<sup id="cite_ref-:5_2-11" class="reference"><a href="#cite_note-:5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Treatment depends on the underlying cause and might involve stopping or changing medications, using drugs to correct hormonal imbalances, or addressing pituitary disorders with appropriate treatments. Managing related conditions such as hypothyroidism or chronic kidney disease is also crucial. A thorough and tailored approach is essential to effectively address the factors contributing to adolescent galactorrhea. </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Witch%27s_milk&action=edit&section=17" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Devidayal_2005-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Devidayal_2005_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFDevidayal2005" class="citation journal cs1">Devidayal MD (November 2005). "A male infant with gynecomastia-galactorrhea". <i>The Journal of Pediatrics</i>. <b>147</b> (5): 712. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jpeds.2005.06.026">10.1016/j.jpeds.2005.06.026</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16291370">16291370</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Pediatrics&rft.atitle=A+male+infant+with+gynecomastia-galactorrhea&rft.volume=147&rft.issue=5&rft.pages=712&rft.date=2005-11&rft_id=info%3Adoi%2F10.1016%2Fj.jpeds.2005.06.026&rft_id=info%3Apmid%2F16291370&rft.aulast=Devidayal&rft.aufirst=MD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://download.journals.elsevierhealth.com/pdfs/journals/0022-3476/PIIS0022347605005822.pdf">"full text"</a> <span class="cs1-format">(PDF)</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=full+text&rft_id=http%3A%2F%2Fdownload.journals.elsevierhealth.com%2Fpdfs%2Fjournals%2F0022-3476%2FPIIS0022347605005822.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span></span> </li> <li id="cite_note-:5-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-:5_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:5_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:5_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-:5_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-:5_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-:5_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-:5_2-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-:5_2-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-:5_2-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-:5_2-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-:5_2-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-:5_2-11"><sup><i><b>l</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLeungPacaud2004" class="citation journal cs1">Leung AK, Pacaud D (August 2004). <a rel="nofollow" class="external text" href="https://www.aafp.org/pubs/afp/issues/2004/0801/p543.html">"Diagnosis and management of galactorrhea"</a>. <i>American Family Physician</i>. <b>70</b> (3): <span class="nowrap">543–</span>550. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15317441">15317441</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Family+Physician&rft.atitle=Diagnosis+and+management+of+galactorrhea&rft.volume=70&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E543-%3C%2Fspan%3E550&rft.date=2004-08&rft_id=info%3Apmid%2F15317441&rft.aulast=Leung&rft.aufirst=AK&rft.au=Pacaud%2C+D&rft_id=https%3A%2F%2Fwww.aafp.org%2Fpubs%2Fafp%2Fissues%2F2004%2F0801%2Fp543.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span></span> </li> <li id="cite_note-:10-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-:10_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:10_3-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:10_3-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-:10_3-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-:10_3-4"><sup><i><b>e</b></i></sup></a></span> <span 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class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422278">4422278</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26023451">26023451</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neonatal+Surgery&rft.atitle=Neonatal+Mastauxe+%28Breast+Enlargement+of+the+Newborn%29&rft.volume=2&rft.issue=3&rft.pages=31&rft.date=2013-07-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4422278%23id-name%3DPMC&rft.issn=2226-0439&rft_id=info%3Apmid%2F26023451&rft_id=info%3Adoi%2F10.47338%2Fjns.v2.43&rft.aulast=Raveenthiran&rft.aufirst=V&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4422278&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a 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href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/36356839">36356839</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pediatric+and+Adolescent+Gynecology&rft.atitle=Pediatric+and+Adolescent+Breast+Conditions%3A+A+Review&rft.volume=36&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E5-%3C%2Fspan%3E13&rft.date=2023-02-01&rft.issn=1083-3188&rft_id=info%3Apmid%2F36356839&rft_id=info%3Adoi%2F10.1016%2Fj.jpag.2022.11.001&rft.aulast=Adekeye&rft.aufirst=Adeseye&rft.au=Lung%2C+Kirsten+C.&rft.au=Brill%2C+Kristin+L.&rft_id=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1083318822003357&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span></span> </li> <li id="cite_note-34"><span class="mw-cite-backlink"><b><a href="#cite_ref-34">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGosiGarla2024" class="citation cs2">Gosi SK, Garla VV (2024), <a rel="nofollow" class="external text" href="http://www.ncbi.nlm.nih.gov/books/NBK537115/">"Galactorrhea"</a>, <i>StatPearls</i>, Treasure Island (FL): StatPearls Publishing, <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30725800">30725800</a><span class="reference-accessdate">, retrieved <span class="nowrap">2024-08-01</span></span></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=StatPearls&rft.atitle=Galactorrhea&rft.date=2024&rft_id=info%3Apmid%2F30725800&rft.aulast=Gosi&rft.aufirst=Shiva+Kumar+Y.&rft.au=Garla%2C+Vishnu+V.&rft_id=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK537115%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWitch%27s+milk" class="Z3988"></span></span> </li> </ol></div></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output 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.navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="Milk150" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="3"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Milk_navbox" title="Template:Milk navbox"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Milk_navbox" title="Template talk:Milk navbox"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Milk_navbox" 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selflink">Newborn</a></li></ul></li> <li><a href="/wiki/Moose_milk" title="Moose milk">Moose</a></li> <li><a href="/wiki/Pig_milk" title="Pig milk">Pig</a></li> <li><a href="/wiki/Sheep_milk" title="Sheep milk">Sheep</a></li></ul> </div></td><td class="noviewer navbox-image" rowspan="5" style="width:1px;padding:0 0 0 2px"><div><span typeof="mw:File"><a href="/wiki/File:Milk_001.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/Milk_001.JPG/63px-Milk_001.JPG" decoding="async" width="63" height="84" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/Milk_001.JPG/95px-Milk_001.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/28/Milk_001.JPG/126px-Milk_001.JPG 2x" data-file-width="1431" data-file-height="1908" /></a></span></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Types</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/A2_milk" title="A2 milk">A2</a></li> <li><a href="/wiki/Baked_milk" title="Baked milk">Baked</a></li> <li><a href="/wiki/Carbonated_milk" title="Carbonated milk">Carbonated</a></li> <li><a href="/wiki/Condensed_milk" title="Condensed milk">Condensed</a></li> <li><a href="/wiki/Evaporated_milk" title="Evaporated milk">Evaporated</a></li> <li><a href="/wiki/Filled_milk" title="Filled milk">Filled</a></li> <li><a href="/wiki/Flavored_milk" title="Flavored milk">Flavored</a> <ul><li><a href="/wiki/Anijsmelk" title="Anijsmelk">Anise</a></li> <li><a href="/wiki/Chocolate_milk" title="Chocolate milk">Chocolate</a></li> <li><a href="/wiki/Coffee_milk" title="Coffee milk">Coffee</a></li> <li><a href="/wiki/Papaya_milk" title="Papaya milk">Papaya</a></li> <li><a href="/wiki/Strawberry_milk" class="mw-redirect" title="Strawberry milk">Strawberry</a></li> <li><a href="/wiki/Vanilla_milk" title="Vanilla milk">Vanilla</a></li> <li><a href="/wiki/Watermelon_milk" title="Watermelon milk">Watermelon</a></li></ul></li> <li><a href="/wiki/Haymilk" title="Haymilk">Haymilk</a></li> <li><a href="/wiki/Malted_milk" title="Malted milk">Malted</a></li> <li><a href="/wiki/Organic_milk" title="Organic milk">Organic</a></li> <li><a href="/wiki/Pasteurized_milk" class="mw-redirect" title="Pasteurized milk">Pasteurized</a></li> <li><a href="/wiki/Powdered_milk" title="Powdered milk">Powdered</a></li> <li><a href="/wiki/Raw_milk" title="Raw milk">Raw</a></li> <li><a href="/wiki/Scalded_milk" title="Scalded milk">Scalded</a></li> <li><a href="/wiki/Skimmed_milk" title="Skimmed milk">Skimmed</a></li> <li><a href="/wiki/Soured_milk" title="Soured milk">Soured</a></li> <li><a href="/wiki/Toned_milk" title="Toned milk">Toned</a></li> <li><a href="/wiki/Ultra-high-temperature_processing" title="Ultra-high-temperature processing">UHT</a></li> <li><a href="/wiki/Ultrafiltered_milk" title="Ultrafiltered milk">Ultrafiltered</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Products</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ayran" title="Ayran">Ayran</a></li> <li><a href="/wiki/Butter" title="Butter">Butter</a></li> <li><a href="/wiki/Buttermilk" title="Buttermilk">Buttermilk</a></li> <li><a href="/wiki/Cheese" title="Cheese">Cheese</a></li> <li><a href="/wiki/Cream" title="Cream">Cream</a></li> <li><a href="/wiki/Curd" title="Curd">Curd</a></li> <li><a href="/wiki/Custard" title="Custard">Custard</a></li> <li><a href="/wiki/Ghee" title="Ghee">Ghee</a></li> <li><a href="/wiki/Ice_cream" title="Ice cream">Ice cream</a> <ul><li><a href="/wiki/Ice_milk" title="Ice milk">Ice milk</a></li></ul></li> <li><a href="/wiki/Breast_milk_jewelry" title="Breast milk jewelry">Jewelry</a></li> <li><a href="/wiki/Filmj%C3%B6lk" title="Filmjölk">Filmjölk</a></li> <li><a href="/wiki/Kefir" title="Kefir">Kefir</a></li> <li><a href="/wiki/Kumis" title="Kumis">Kumis</a></li> <li><a href="/wiki/Milkshake" title="Milkshake">Milkshake</a></li> <li><a href="/wiki/Skyr" title="Skyr">Skyr</a></li> <li><a href="/wiki/Sour_cream" title="Sour cream">Sour cream</a> <ul><li><a href="/wiki/Cr%C3%A8me_fra%C3%AEche" title="Crème fraîche">Crème fraîche</a></li></ul></li> <li><a href="/wiki/Whey" title="Whey">Whey</a></li> <li><a href="/wiki/Ymer_(dairy_product)" title="Ymer (dairy product)">Ymer</a></li> <li><a href="/wiki/Yogurt" title="Yogurt">Yogurt</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Containers</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bag-in-box" title="Bag-in-box">Bag-in-box</a></li> <li><a href="/wiki/Glass_milk_bottle" title="Glass milk bottle">Glass milk bottle</a></li> <li><a href="/wiki/Jug" title="Jug">Jug</a></li> <li><a href="/wiki/Milk_bag" title="Milk bag">Milk bag</a></li> <li><a href="/wiki/Milk_carton" class="mw-redirect" title="Milk carton">Milk carton</a></li> <li><a href="/wiki/Milk_churn" title="Milk churn">Milk churn</a></li> <li><a href="/wiki/Milk_crate" title="Milk crate">Milk crate</a></li> <li><a href="/wiki/Milk_delivery" title="Milk delivery">Milk delivery</a></li> <li><a href="/wiki/Plastic_milk_container" title="Plastic milk container">Plastic milk container</a></li> <li><a href="/wiki/Square_milk_jug" title="Square milk jug">Square milk jug</a></li> <li><a href="/wiki/Tetra_Brik" title="Tetra Brik">Tetra Brik</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Topics</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Milk_allergy" title="Milk allergy">Allergy</a></li> <li><a href="/wiki/Dairy" title="Dairy">Dairy</a></li> <li><a href="/wiki/Fidel_Castro_and_dairy" title="Fidel Castro and dairy">Fidel Castro and dairy</a></li> <li><a href="/wiki/Lactation" title="Lactation">Lactation</a> <ul><li><a href="/wiki/Breastfeeding" title="Breastfeeding">Breastfeeding</a></li></ul></li> <li><a href="/wiki/Milking" title="Milking">Milking</a> <ul><li><a href="/wiki/Milking_pipeline" title="Milking pipeline">Pipeline</a></li></ul></li> <li><a href="/wiki/Milkmaid" title="Milkmaid">Milkmaid</a></li> <li><a href="/wiki/Milkman" class="mw-redirect" title="Milkman">Milkman</a></li> <li><a href="/wiki/Milk_quotas_in_the_United_Kingdom" title="Milk quotas in the United Kingdom">Milk quotas in the United Kingdom</a></li> <li><a href="/wiki/World_Milk_Day" title="World Milk Day">World Milk Day</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="3"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" 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