a.k.a. Nipple Discharge

Approach

Investigations

• b-HCG, Prolactin , TSH (< 5), Medication Hx
• Mammogram, US and Biopsy if suspecting BC

DDx

• Main DDx
  • Breast cancer
  • Anterior Pituitary Diseases /Hypothyroidism ↓ → High level of TSH stimulate prolactin

• Discharge from Breast cancer causes tend to be:
  • Unilateral
  • Spontaneous
  • Bloody (but very rare)
  • Seroanguinous
  • Associated findings:
    • Enlarged axillary lymph node
    • Eccentric mass
    • Skin changes, Peau d’orange
  • DDx
    • Duct ectasia
    • Infection
    • Benign Intraductal papilloma
• Discharges from Hyperprolactinemia ↑ causes tend to be:
  • Bilateral
  • Milky
  • DDx
    • Medications
      • Anti-psychotic (D2i)
    • Other systemic conditions:
      • Hypothyroidism ↓
      • Hypogonadism (man)

Management