Breast Discharge - Differential Diagnosis Algorithm

High Prolactin + Normal TSH

 • Microprolactinoma

 • Steroid Hormone Intake

 • Chronic Renal Failure

 • Stress (e.g. Pregnancy, Breast Stimulation, Trauma/Surgery)

High Prolactin + Normal/ Low TSH

 • Pituitary Macroadenoma

 • Dopamine Inhibition

 • Pituitary Stalk Compression/Lesion

Autonomous Production

 • Renal Cancer or Failure

 • Lactotroph Adenoma

 • Bronchogenic Tumor

 • Contraceptive Pill/Patch/Ring

High Prolactin + High TSH

 • Primary Hypothyroidism



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