Nipple discharge
- Physiologic
- Discharge only with compression
- Multiple duct involvement
- Bilateral
- Fluid may be clear, yellow, white or dark green
- Pathologic
- Spontaneous discharge
- Bloody
- Unilateral
- Associated with a mass
- Physiologic/Endocrinologic Discharge
- Lactation
- Milk produced in presence of postpartum exocrin, parathyrin, thyroxine, cortisol, growth hormone and placental lactogen
- Milk secreted via stimulation of lobular and ductal epithelium by PRL
- Milk ejected via stimulation of muscular walls of lactiferous ducts by oxytocin
- Oxytocin and PRL secreted by pituitary in response to nipple stimulation
- Galactorrhea:
- Milk secretion unrelated to pregnancy/lactation
- Usually due to hyperprolactin state, though can be idiopathic with normal prolactin (PRL)
- Can occur via:
- Chronic breast stimulation (nipple manipulation, rubbing on bra)
- Oral Contraceptive Pills (OCPs) – E can stimulate PRL secretion
- Drugs that inhibit dopamine (loss of tonic inhibition of PRL)
- Hypothalamic/pituitary disease interfering with DA release
- Prolactinoma
- Hypothyroidism
- Chronic renal failure
- Chest wall injury – healing wound stimulates PRL release
- Pathologic Discharge
- Intraductal papilloma: monotonous proliferation of papillary cells growing into the lumen
- Fluid typically straw-colored, transparent, sticky
- Duct ectasia: distention of subareolar ducts
- Fibrocystic disease: associated irritation within the duct
- Papillomatosis: formation of multiple papillomas
- Associated with small increase in breast cancer risk
- Intraductal hyperplasia: increased number of epithelial cells lining the ducts
- Cells appear benign but associated with small increase in breast cancer risk
- Breast cancer: risk much increased if mass associated with abnormal discharge
History and Symptoms
- Description of Discharge
- Unilateral vs. bilateral (bilateral almost always due to endocrinologic cause)
- Spontaneous vs. provoked
- Bloody vs. nonbloody
- Endocrine Symptoms
- Irregular menses,
- thyroid symptoms,
- endo review of symptoms (& visual fields) if prolactinoma suspected
- Medical Conditions
- Renal failure,
- thyroid disease
- Medications
- Potential causes of hyperprolactinemia