Differential Diagnosis for Constantly Erect and Sore Nipples with Discharge
Single Most Likely Diagnosis
- Hormonal Imbalance: Given the patient's age and mention of hormonal changes, an imbalance, particularly an increase in prolactin levels, could lead to nipple discharge and soreness. This condition is relatively common and aligns with the patient's symptoms and health background.
Other Likely Diagnoses
- Galactorrhea: This condition, characterized by spontaneous milk production not associated with childbirth or nursing, can cause nipple discharge. It's often linked to hormonal imbalances, which the patient is experiencing.
- Ductal Ectasia: A condition where the milk ducts in the breast become widened, leading to symptoms like nipple discharge, inversion, or soreness. It's more common in women around the age of 40.
- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can lead to changes in nipple sensitivity and discharge due to their impact on hormonal balances.
Do Not Miss Diagnoses
- Breast Cancer: Although less likely, breast cancer, particularly ductal carcinoma in situ (DCIS) or invasive ductal carcinoma, can present with nipple discharge. It's crucial to investigate further to rule out malignancy, especially if the discharge is bloody or from one breast only.
- Pituitary Tumor: A prolactinoma, a type of pituitary tumor, can cause an overproduction of prolactin, leading to symptoms like nipple discharge and soreness. Early detection is vital for effective management.
Rare Diagnoses
- Neurofibromatosis: A genetic disorder that can lead to various symptoms, including changes in skin pigmentation and the growth of tumors along nerves. Rarely, it might cause nipple discharge due to associated hormonal imbalances or tumors affecting hormone production.
- Spontaneous Nipple Discharge due to Other Endocrine Disorders: Conditions like acromegaly or polycystic ovary syndrome (PCOS) can also lead to hormonal imbalances that might result in nipple discharge, though they are less directly associated with the symptom compared to prolactin-related issues.