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Nipple discharge is a common clinical presentation encountered in primary care, with a wide spectrum of underlying causes. While many instances of nipple discharge are benign and physiologic in nature, it is essential for clinicians to be vigilant and differentiate between benign and pathologic nipple discharge (PND). Understanding the characteristics and clinical features associated with PND is crucial in ensuring timely diagnosis and appropriate management.
| Type of Discharge | Causes |
|---|---|
| Physiologic Nipple Discharge | • Pregnancy • Lactation • Postpartum galactorrhea (up to two years after delivery) • After spontaneous or intentional termination of pregnancy • Fibrocystic changes of the breast • Hormonal fluctuations associated with the menstrual cycle • Duct ectasia • Intraductal papilloma |
| Pathologic Nipple Discharge | • Infection (periductal mastitis) • Breast abscess • Neoplastic processes (e.g., intraductal carcinoma, Paget disease of breast) • Pituitary tumor/prolactinoma • Thoracic/breast trauma • Systemic diseases that elevate prolactin levels (e.g., hypothyroidism, disorders of the pituitary gland or hypothalamus, chronic kidney or liver disorders) • Medications inhibiting dopamine secretion (e.g., opioids, oral contraceptives, antihypertensives like methyldopa, reserpine, verapamil, antidepressants, antipsychotics) |
| Specific Considerations | • Bilateral milky nipple discharge is normal during pregnancy and lactation, lasting up to a year post-delivery or post-breastfeeding. • Galactorrhea in... |
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