Endocrinology - Breast Discharge: By Jeannette Goguen M.D.

Author: Medskl.com

There are several serious conditions that must not be missed that cause breast discharge, including breast cancer and an intracranial mass leading to the production of milk. The first step in evaluating a patient with breast discharge is to decide whether there is an underlying breast condition present, or if the patient actually has galactorrhea – defined as the production of milk. Breast conditions causing discharge include benign papilloma but more worrisome is breast cancer. Red flags – which indicate an increased risk of a malignant breast tumor – include age over 40, and discharge that is unilateral, spontaneous, bloody or serosanguinous. The breasts should be checked to see if the discharge is uniductal and if there are any associated masses.

The patient will need a full breast and local lymph node examination. You should order mammography and refer any patient with possible breast cancer to a breast centre. Patients with galactorrhea typically present with milky, bilateral, and expressible discharge, and usually have an elevated prolactin level. They often complain of oligo- or amenorrhea (and for men – low libido and erectile dysfunction). There are five causes to consider: 1. Physiologic: are they pregnant (now or recently), breastfeeding or have they had chest wall trauma or disease? 2. Could they have an intracranial mass in the sellar lesion? Either a prolactinoma or a non-functional adenoma can cause galactorrhea by raising prolactin, the latter through stalk effect (i.e.

Blocking dopamine inhibition of prolactin); high prolactin levels are measured in the blood. You must examine cranial nerves II-VI and look for signs of pituitary hormonal deficiencies (amenorrhea, fatigue, weight loss, nausea, dizziness, constipation, cold intolerance). These patients will need a sellar MRI and referral to an endocrinologist. 3. Are they taking medications that raise prolactin levels, like antipsychotic agents or gastrointestinal motility agents? 4. Do they have renal or liver failure, causing reduced clearance of prolactin? 5. Do they have primary hypothyroidism? The key message regarding any patient – male or female – presenting with breast discharge, is to rule out the possibility of breast cancer, and make sure that a pituitary adenoma, or other sellar lesion is not the cause of the discharge.

Endocrinology - Breast Discharge: By Jeannette Goguen M.D.

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