A 33-year-old woman is referred with nipple discharge. Which of the following statement(s) is/are true concerning her diagnosis and management?

a. Bilateral galactorrhea is suggestive of an underlying endocrinopathy

c. Expressible bloody nipple discharge should be evaluated with a ductogram

At one time or another, many women notice a nipple discharge. The most common physiologic basis for nipple discharge is lactation. Milk may continue to be secreted intermittently for as long as two years after breast feeding has stopped, particularly with breast stimulation. A milky whitish discharge, usually bilateral, that is not related to lactation or breast stimulation is termed “galactorrhea.” The presence of bilateral galactorrhea should prompt an evaluation for underlying endocrinopathy causing increased prolactin secretion by the pituitary. Classically, this is associated with amenorrhea, but galactorrhea may be the only sign of hypoprolactinemia. Nipple discharges associated with fibrocystic disease are generally, green, yellow, or brown, Intraductal papillomas and cancer lead to a bloody or blood-tinged serous discharge. The brownish discharge of fibrocystic disease can easily be confused with old blood. A guaiac test or simply dabbing the discharge with a gauze pad and examining the stain can usually differentiate the two. A bloody or blood-tinged discharge must be promptly evaluated to exclude carcinoma. If the discharge is expressible at the time the patient is seen, a contrast ductogram may be obtained.