Nipple Discharge [keywords]
- Hyperprolactinemia Secondary to Pituitary Microadenoma versus Haloperidol-A Diagnostic Enigma: A Case Report and Brief Review. [JOURNAL ARTICLE]
- Curr Drug Saf 2016 Jul 19.
Hyperprolactinemia can be caused by medications, primarily antipsychotics, or by anterior pituitary tumors. The consequences of hyperprolactinemia including gynecomastia, galactorrhea, and sexual dysfunction are very disturbing for males and females. It is sometimes difficult to differentiate the etiology of hyperprolactinemia from a clinical perspective.Identification of the etiology of hyperprolactinemia requires a careful review of the causes and appropriate work-up.A 55-year-old African American male with extensive psychiatric history and non-adherence to treatment was admitted from nursing home for aggression and psychotic symptoms. The patient was noted to have mild bilateral breast enlargement about ten days after hospitalization. Prolactin level done on August 26, 2014 was 93.8 ng/mL, and on September 5, 2014 was 112 ng/mL. The patient's medications included haloperidol decanoate 150 mg q28d, haloperidol 10 mg po bid and benztropine 0.5 mg po bid. He did not have any other clinical signs or symptoms of hyperprolactinemia. He was also seen by an endocrinologist. MRI of the pituitary gland done on September 3, 2014, showed a 2.4 mm pituitary microadenoma. Bromocriptine was started at 1.25 mg qhs and titrated to 2.5 mg bid.Prolactin level dropped from 112 ng/mL on September 5, 2014 to 99 ng/mL on September 9, 2014, 61.2 ng/mLon September 23, 2014 and 3.0 ng/mL on February 9, 2015.Diagnosis and etiology of hyperprolactinemia were complicated by the minimal nature of clinical symptoms, the type of antipsychotic agent and the prolactin level. The MRI facilitated the diagnosis of pituitary microadenoma and further treatment option with bromocriptine. MRI of the pituitary is indicated for patients with hyperprolactinemia where the etiology is not clearly due to medication.
- Imaging features of idiopathic granulomatous mastitis - Case report. [Case Reports]
- Rev Assoc Med Bras 2016 Jul; 62(4):303-6.
Idiopathic granulomatous mastitis is a rare disorder of unknown etiology. This disease occurs mostly in young women and often after the lactation period. Women usually present with a fixed, painful mass, sparing the retroareolar region, associated with skin thickening and possible ulceration that mimics carcinoma. Nipple discharge can be present and bilateral involvement may occur in up to 25% of cases. In this case report, we present a typical case of histologically confirmed idiopathic granulomatous mastitis, highlighting the imaging findings, including magnetic resonance imaging (MRI), which may favor this diagnosis and enable better clinical management of these patients.
- Citalopram-Induced Galactorrhea in an Adolescent. [JOURNAL ARTICLE]
- Clin Neuropharmacol 2016 Jul 19.
- Breastfeeding Support in the Early Postpartum: Content of Home Visits in the SILC Trial. [JOURNAL ARTICLE]
- Birth 2016 Jul 15.
The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits.SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented.Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities.New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education.
- An assessment of serum prolactin levels among infertile women with galactorrhea attending a gynecological clinic North-West Nigeria. [Journal Article]
- Niger Med J 2016 May-Jun; 57(3):178-81.
Galactorrhea is a common manifestation of hyperprolactinemia but may not always be present in women with hyperprolactinemia. This study was, therefore, undertaken to assess the serum prolactin levels of infertile women presenting with galactorrhea and to determine the prevalence of hyperprolactinemia among them.This was a retrospective study of serum prolactin levels of 63 female partners of infertile couples attending the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria, who were found to have galactorrhea from January 1, 2012, to December 31, 2013. Ethical clearance was obtained. Solid phase enzyme-linked immunosorbent assay was used to measure serum prolactin. Sociodemographic characteristics were determined. The data obtained were analyzed using SPSS version 17.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate.The average age of the women was 27.9 ± 5.6 years. In half of the cases (50%), galactorrhea was associated with menstrual disturbances, mainly amenorrhea (23.3%). Although most (63.3%) of the clients had normal serum prolactin level despite being galactorrheic, averagely there was a marked elevation in serum prolactin of as high as 40.3 ± 52.3 ng/mL.We conclude, therefore, that the prevalence of hyperprolactinemia in this study was low when compared with other studies and that galactorrhea does not always indicate raised serum prolactin levels.
- Different Levels of CEA, CA153 and CA125 in Milk and Benign and Malignant Nipple Discharge. [Journal Article]
- PLoS One 2016; 11(6):e0157639.
The aim of this study was to assess the diagnostic values of three breast tumor markers (i.e., CEA, CA153 and CA125) in milk and nipple discharge in the prediction of different breast diseases diagnoses.Three hundred thirty-six patients (96 breast cancer and 240 benign disease patients) with nipple discharge and a control group of 56 healthy parturient participants were enrolled in the present study. Nipple discharge samples were preoperatively collected from the patients, and milk was collected from the colostrum of the parturient participants. The samples were assayed for the CEA, CA153 and CA125 levels. Cutoff values were determined for the detection of breast diseases using ROC curves.The levels of CEA, CA153 and CA125 were significantly different between the nipple discharge and the milk (all ps < 0.001). In the nipple discharge, the CEA and CA153 levels in the breast cancer group were significantly greater than those in the benign group (all ps < 0.001), and cutoff values of 263.3 ng/mL and 1235.3 U/mL, respectively, were established. However, the expression of CA125 did not differ significantly between the breast cancer and benign groups.Differences in the apparent expression levels of CEA, CA153 and CA125 in patients with nipple discharge and healthy persons were validated. The present data suggest that CEA and CA153 might potentially be useful in the differential diagnoses of benign tumors and breast cancer. CA125 did not seem to be useful for breast cancer detection.
- A case of galactorrhea during paroxetine treatment. [Journal Article]
- Int J Psychiatry Med 2016 Apr; 51(3):302-5.
Paroxetine is one of the selective serotonin reuptake inhibitor antidepressant drugs. Galactorrhea can be seen during antidepressant treatments. There are a few reports in literature on paroxetine use and related prolactin level changes. We present a case that was receiving paroxetine in whom despite low blood levels of the drug, hyperprolactinemia, and galactorrhea was found. We present a case that was receiving paroxetine despite low drug blood levels, hyperprolactinemia, and galactorrhea was found in this article.
- Metaplastic carcinoma of breast: A case series of seven patients from a tertiary care center and review of literature. [Journal Article]
- Gulf J Oncolog 2016 May; 1(21):74-6.
Metaplastic carcinoma of breast (MCB) is a rare histological subtype of breast carcinoma and accounts for less than 1 percent of the total breast cancer cases. Here we are reporting a series of seven patients of MCB from single institute along with review of literature.Patients records from January 2008 to August 2014 were retrieved to search for MCB patients. A etrospective review was conducted to document the clinicopathological features, treatment and outcomes of these patients. The data was entered in a predesigned proforma document.Seven patients were diagnosed to have MCB during this period. Most common symptom at presentation was lump in the breast with associated discharge per nipple in one patient. On histology, there was no definite differentiation in four patients while one patient had spindle cell neoplasia, one had osteoid and chondroid neoplasia respectively. Five patients underwent modified radical mastectomy while other two patients underwent simple mastectomy. All the patients were pathologically node negative and triple negative breast cancer. Adjuvant chemo-radiotherapy was given to all patients. Median follow up was 4 years (Range 3-6 years). Three out of seven patients completed 5 years of follow up. One patient developed isolated liver metastasis six years after completion of the treatment and she lost to follow up for further treatment.Metaplastic carcinoma of breast is a rare disease entity and there are no specific treatment guidelines. The prognosis of patients in this rare sub group remains poor and multi institutional studies evaluating role of new therapies may be required to improve outcome.
- Rural Women's Awareness about Breast Cancer in Southeastern Iran: a Cross-Sectional Study. [Journal Article]
- Asian Pac J Cancer Prev 2016; 17(4):1875-9.
Breast cancer is the most common cancer among women worldwide. A very important factor in the timely treatment and prevention of progression is high breast cancer awareness. Rural women are at risk of latte stage breast cancer due to poor education and lack of access to medical facilities.This cross-sectional-descriptive study was conducted on 266 women (out of 300) aged over 18 in rural areas of Zabol, Southeastern Iran during July 2015 to October 2015. The data collection tool was a researcher-made questionnaire that measured participant knowledge of breast cancer in four aspects (general awareness, risk factors, mammography, and symptoms). SPSS 22 was used for statistical analysis.Out of 266 participants, age information was available for 261. The age range was between 19 and 62, with a mean of 27±2.1 years. Most participants (154, 57.9%) had an average overall awareness of breast cancer. In the general awareness dimension, most participants (130, 48.9%) had poor scores. Most (166, 62.4%) also had average awareness about risk factors and many (137, 51.5%) had good awareness about mammography. Most participants did not know that changes in breast shape (232, 88.2%), dimpling of breast skin (192, 72.3%) and nipple discharge (183, 69.6%) are the main symptoms of breast cancer. ANOVA statistical analysis showed a significant relationship between awareness level and participant education and occupation (<0.05).This study indicated average awareness of participants about breast cancer. Since rural women have lower levels of education, it is recommended that educational courses with contents about breast cancer, its risk factors, and symptoms be held for these women.
- Venlafaxine-Associated Euprolactinemic Galactorrhea and Hypersexuality: A Case Report and Review of the Literature. [Journal Article]
- J Clin Psychopharmacol 2016 Aug; 36(4):399-400.