Nipple Discharge

 

Require referral:

• Under 50 years old
  • Bloodstained or clear discharge
  • Discharge of any nature from a single duct
  • Discharge sufficient to stain clothes
• Over 50 years old
  • Any discharge

Do not usually require treatment or referral:

• Patients with a small volume of coloured or milky discharge from multiple ducts in females under age 50 years with no other breast symptoms – see Galactorrhoea advice below.

 

All patients referred with breast symptoms are seen within 2 weeks.

 

Galactorrhoea

Characterised by a large amount of milky discharge from multiple ducts

Management 

History/examination to consider cause: physiological, drugs, thyroid disorder, pituitary tumour (visual field defects/ new headaches) / prolactinoma (menstrual disturbance/acne)

 

Check serum prolactin/TSH   

• For serum prolactin the upper end of normal range is 496 mU/L in women and 324mU/L in men
• Raised prolactin levels are common (e.g. due to higher dose COCP or stress).
• In prolactinoma a very high value (over 1000 and usually several 1000mU/L) is expected.

 

If a patient has a very high serum prolactin and is not pregnant or breast feeding consider referral to Endocrinology not to breast surgery

 

For further information and interpretation of tests see patient.co.uk. The duty biochemist at RCHT can be contacted via switchboard for advice.

 

 

 

Date Reviewed                              November 2021

Next Review Date                          November 2022

Author                                            Dr I Boyd, RMS GP Sifter

Reviewed By                                  Dr M Attridge, RMS GP Sifter

Contributor                                     Dr Rebecca Osborne, GPwSI Breast, RCHT

 

 

Version No.  3.0