Merck Manual

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Some Causes and Features of Nipple Discharge

Some Causes and Features of Nipple Discharge

Cause

Common Features*

Tests

Benign breast disorders

Intraductal papilloma (a benign tumor in a milk duct)—the most common cause

A bloody or pink discharge from one breast

Usually ultrasonography

Additional tests depending on the results (evaluation as for breast lumps)

Mammary duct ectasia (dilated milk ducts)

A bloody, pink, or multicolored (puslike, gray, or milky) discharge from one or both breasts

Same as for intraductal papilloma

Fibrocystic changes (including pain, cysts, and general lumpiness)

A lump, often rubbery and tender, usually developing before menopause

Possibly a pale yellow, green, or white discharge

Possibly a history of having breast lumps

Same as for intraductal papilloma

Pain, tenderness, redness, warmth, or a combination that begins suddenly in a breast

Often fever

With an abscess, a tender lump and possibly a puslike discharge that smells foul

Physical examination (infection is usually obvious)

If the discharge does not resolve with treatment, evaluation as for intraductal papilloma

Usually intraductal carcinoma or invasive ductal carcinoma

Possibly a palpable lump, changes in the skin, or enlarged lymph nodes, most often in the armpit

Sometimes a bloody or pink discharge

Same as for intraductal papilloma

Increased levels of prolactin†

Various disorders, including the following:

A milky (not bloody) discharge, usually from both breasts

No lumps

Possibly menstrual irregularities or no menstrual periods (amenorrhea)

Blood tests to measure prolactin and thyroid-stimulating hormone levels

A review of drugs being taken

If the prolactin or thyroid-stimulating level is elevated, MRI of the head

Intolerance of cold, sluggishness, constipation, or weight gain

  • Disorders of the pituitary gland or hypothalamus (part of the brain)

Possibly hormonal abnormalities (such as absence of menstrual periods or infertility), changes in vision, or headaches

  • Chronic kidney or liver disorders

With liver disorders, ascites or jaundice

In people known to have a kidney or liver disorder

Certain drugs including

  • Opioids

  • Oral contraceptives

  • Some drugs used to treat stomach disorders (such as cimetidine, ranitidine‡, and metoclopramide)

  • Some antidepressants and phenothiazines (drugs used to treat nausea or psychosis), such as prochlorperazine

  • Some antihypertensives (such as atenolol, labetalol, methyldopa, reserpine, and verapamil)

Blood tests to measure prolactin and thyroid-stimulating hormone levels

A review of drugs being taken

If the prolactin or thyroid-stimulating level is elevated, MRI of the head

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† Prolactin is a hormone that stimulates production of breast milk.

Ranitidine (taken by mouth, intravenously, and over the counter) has been removed from the market in the United States and in many other countries because of unacceptable levels of N-nitrosodimethylamine (NDMA), which is a substance that probably causes cancer.

MRI = magnetic resonance imaging.