Differential Diagnosis for Nipple Discharge
The patient presents with bilateral yellow nipple discharge, which can be caused by various conditions. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Galactorrhea: This condition is characterized by the spontaneous flow of milk from the breast, which is not associated with childbirth or nursing. The patient's normal prolactin level does not rule out galactorrhea, as it can be caused by various factors, including hormonal imbalances, certain medications (such as sertraline), and thyroid disorders. The presence of bilateral yellow nipple discharge and the absence of other symptoms make galactorrhea a likely diagnosis.
- Other Likely diagnoses
- Ductal ectasia: This condition is characterized by the dilation of the milk ducts, which can cause nipple discharge. The patient's age and the presence of bilateral yellow nipple discharge make ductal ectasia a possible diagnosis.
- Intraductal papilloma: These are small, benign tumors that grow in the milk ducts and can cause nipple discharge. Although the patient does not have a palpable mass, intraductal papillomas can be small and not detectable on physical examination.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Breast cancer: Although the patient's mother had breast cancer at age 59, and the patient is relatively young, breast cancer should not be ruled out. A thorough examination and imaging studies (such as mammography or ultrasound) should be performed to exclude breast cancer.
- Pituitary tumor: Although the patient's prolactin level is normal, a pituitary tumor (such as a prolactinoma) can cause galactorrhea and other symptoms. A pituitary tumor can be life-threatening if left untreated, making it a "do not miss" diagnosis.
- Rare diagnoses
- Thyroid disorders: Although the patient's TSH level is within normal limits, some thyroid disorders (such as hyperthyroidism) can cause galactorrhea. However, this is a rare cause of nipple discharge.
- Neurogenic causes: Certain neurogenic conditions (such as spinal cord injuries or nerve damage) can cause galactorrhea. However, these conditions are rare and would likely be associated with other symptoms.