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Nipple discharge

  • Common ddx

    • pregnancy, hyperprolactinemia, papillary cystadenoma
  • Serious ddx

    • breast cancer
  • Labs

    • prolactin (if milky or bilateral)
    • mammogram (> 30 yo) or ultrasound (< 30 yo)
    • FNA (if bloody)
    • hCG (high in pregnancy or large cell CA of lung)
    • CT if prolactin elevated
    • ductogram
  • Bloody ddx

    • papillary cystadenoma
    • Paget's
    • cancer
  • Milky ddx

    • hyperprolactinemia
    • prolactinoma
    • antipsychotics (risperidone)
    • pregnancy
  • Px

    • breast exam (mass, discharge, erythema)
  • Pimp Qs

    • antipsychotics -> dopamine blockade -> hyperprolactinemia

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