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Allocations from a nipple

Table of contents
Allocations from a nipple
Anamnesis
Physical inspection
Diagnostic testings
Assessment and diagnostic approach

Close concepts: a galactorrhoea, bloody allocations from a nipple

Milk is the natural secret of a mammary gland containing lactose. Quite often it is difficult to determine by outward whether allocations from a nipple are milk. Pathological secretion of milk is called a galactorrhoea. Besides, serous, muddy, serous and bloody and hemorrhagic allocations from nipples meet. From fistulas at chronic abscesses of a mammary gland pus can be emitted. At superficial injuries of a nipple or other part of a breast exudate is emitted.

The allocations containing milk (galactorrhoea)

The galactorrhoea which is not stopping after the birth of the child and followed by an amenorrhea received the name of an illness of Frommel or Kiari's syndrome — Frommelya. The amenorrhea syndrome — a galactorrhoea can be not connected neither with pregnancy, nor with a giperprolaktinemiya. If the galactorrhoea is not connected with childbirth, and is combined with a hypophysis tumor, it is called Forbes's syndrome — Albright. In cases, when there is no instructions on a hypophysis tumor, it is called a syndrome Argonts — Del-Castillo. These descriptive terms are of mainly historical interest. Now it is known that disturbances of hypothalamic and pituitary function can be shown differently, it is not necessary to confuse a clinical picture to the diagnosis of a disease.

Epidemiology

Meningiomas of area of the Turkish saddle, cranyopharyngioma and other tumors of a brain can be followed by a galactorrhoea. The galactorrhoea can be also caused by diffusion damages of a brain like traumatic encephalopathy and a tuberous sclerosis. Cases when the galactorrhoea, apparently arose e bonds with diseases and damages of skin in a thorax, it as a sarcoidosis, shingles are described; after removal of a tattoo, a thoracotomy, a laparotomy and even owing to irritation of an axillary hollow a crutch.

The galactorrhoea is usually carried to diseases of endocrine system. Most often among hypophysis tumors as the reason of a galactorrhoea consider prolaktinsekretiruyushchy adenoma, however there are messages on communication of a galactorrhoea with the chromophobic adenomas, adenomas cosecreting thyritropic hormone (TTG) and with an illness of Kushinga. The galactorrhoea can be caused also by other endocrine tumors, such as feminizing tumors of an adrenal gland and a tumor of granulosa cells. Various tumors producing the hormonal active agents or substances blocking receptors, for example, an ovsyanokletochny cancer, a choriocarcinoma, a hypernephroma, vesical drift, a teratoma of an ovary and a myeloma are the rare reasons of a galactorrhoea. The galactorrhoea often accompanies a syndrome of a polycystosis of ovaries as clinical implication or as treatment complication medroksiprogesteronatsetaty.

Function of a thyroid gland exerts a great influence on a lactation. Emergence of a galactorrhoea can help to make the diagnosis of a spontaneous hypothyroidism at women during the period before approach of a menopause. The galactorrhoea can be caused also by a hyperthyroidism, in particular a pituitary TTG-thyrotoxicosis.
Galactorrhoea at men an ominous symptom. At men with hypophysis tumors the galactorrhoea is improbable at early stages for bolevaniye and therefore at emergence of this symptom the forecast of an illness is adverse. At men the galactorrhoea can be the first symptom of an acromegalia, the Galactorrhoea can arise at dysfunction of testicles, both primary, and developed as a result of chemotherapy. In effect the galactorrhoea does not cause fears in men only if it develops in the recovery period after starvation (sometimes against an overeating) or in connection with reception of medicines (tab).

The medicines capable to call haberdashery

General name

Trade name

Action mechanism

Fenotiazinovy and other antipsychotic
drugs

 

Blockade dopaminergiche-
sky receptors

Hlopromazin

Thorazinum, Promapar, Aminazine

Prochlorperazine

Compazinum

Triphtazinum

Stelazinum

Ftorfeiazin

Prolixinum,    Permitil,

 

Trimeprazinum

Fluphenazin

 

Temaril

Thioridazine

Mellaril

Haloperidol

Galdon

Molindon

Moby

Antidepressants

 

 

Imipraminum

 

Tofranil,     Zhanimin, SK-promin

 

It is not studied

Ameksapin

Asendin

Perhaps, blockade of dopaminergic    receptors

Amitriptyline

Elavil, Endep, Amitid,

It is not studied

 

Doksepin

Triptizolum

 

 

Sinekvan, Adalene

It is not studied

Benzodiazepines

Librium,       SK-ligen,

 

It is not studied

Chlordiazepoxide

Librium,       SK-ligen,
A-poksid, Elenium

 

Chlordiazepoxide

 

 

Diazepam

Valium, Seduxenum, Relanium

It is not studied

Amphetamines

 

 

Amphetamine

 

Benzedrine

 

It is not proved in the relation
galactorrhoea, but causes a gynecomastia

Dekstroamfetamin

Deksedrin

 

Metamphetaminum

Desoxynum

 

Amphetamine complex

Bifetamin

 

Hypotensive

 

 

Methyldopum

Aldometum

It is not studied

Reserpinum

Serpasil, Sandril, Reserpoidum

Exhaustion of stocks of a dopamine

Rauwolfia

Raudixinum, Raunatinum

Exhaustion  of stocks of a dopamine

Hormonal drugs

 

 

 

Estrogen

Premarin, Ogen

 

 

Premarin, Ogen

 

At men  stimulates
synthesis and secretion about -
lactine

Tamoxifenum

Nolvadeks

It is not studied, it is observed
at  women,   patients
cancer of milk gland before a menopause

Contraceptives

 

 

 

 

Various it is tableted -
ny drugs

  It is not studied,  meets
against and after courses
reception

Medroksiprogesteron

Depot-Depo-Provera

 

It is not studied

 

 Other drugs Metoclopramidum
Meprobamate   (anxiolytic)
Verapamil     (blocker of calcium channels)
Cimetidinum     (blocker H2-gistaminoretsepto-rov)
Isoniazid    (antitubercular drug)

 

Raglan, Cerucal
Equanil, Miltaun, SK-bamat
Isoptinum, Finoptinum, Kamchatka beaver
Tagametum
Nydrazidum, Nikonil

 

Blockade dopaminergiche-
sky receptors
It is not proved
Perhaps, intracellular hypocalcemia
It is not studied
It is not studied

 

The galactorrhoea at children indicates a serious endocrine disease. Secretion of milk at children before puberty is possible in case of significant increase in level of estrogen and prolactin. At babies this phenomenon received the name "vedmino milk" (hexen-milch — it.). In several weeks after the birth this short-term effect caused by influence of hormones of a maternal organism and placenta disappears.

Physiology

The mammary gland is fairly called a mirror of endocrine system [23]. The main hormone operating on tissue of a mammary gland, prolactin, phylogenetic the most ancient among polypeptide hormones. It would be possible to call it "life hormone" as it existed and managed feeding and reproduction even before phylogenetic development of mammary glands, at amphibiouses prolactin participates in adaptation to water and land habitat, at fishes — in spawning regulation.

At the person prolactin possesses thin, diverse and, sometimes, multidirectional action. Level of secretion of prolactin varies within a day, for example it considerably raises during a dream in a phase of fast movements of eyeglobes (REM phase) and also increases under the influence of a stress. Content of prolactin is higher at the beginning of a lactation, however in process of continuation of a lactation often decreases to norm. Its influence on fabric of chest gland is defined by effect of other hormones, in particular estrogen. Pregnancy causes considerable activation of lactotropic mechanisms of a hypophysis, contraceptive drugs and other chronic stimulators of pituitary system possess the same action. For the present it is not clear whether similar stimulation promotes development prolactin - the cosecreting adenomas and this process is how reversible.

Most of researchers connect the galactorrhoea reason with a hypothalamus, in particular when the usual reasons of a galactorrhoea do not manage to be found. Really, a hypothalamus — the main regulator of triple functions of a hypophysis. The neuroendocrinal mediator a dopamine has on prolactin secretion paradoxical effect, allegedly due to allocation stimulation the prolactin-the inhibiting factor (PIF) in a hypothalamus; this factor then is transferred to a hypophysis on the portal blood circulatory system of a hypophysis. Increase of level of prolactin at prolactin - not producing hypophysis tumors, and also at cranyopharyngiomas, a syndrome of "an empty Turkish saddle" and in other difficult cases it is probably possible to explain with disturbance of secretion or transfer mutual fund. Medicines derivative a fenotiazin and tricyclic amines block dopamine receptors in a hypothalamus and lead to emergence of a galactorrhoea. Reserpinum and its analogs exhaust dopamine stocks in a brain. Products of a metabolism of some drugs, for example a digitalis, can block dopamine receptors.

It is considered that emergence of a galactorrhoea after the delivery and lactations, and also as a result of a stress or skin stimulation is caused by disturbance of neuroendocrinal balance of gipotalamo-pituitary system. Often it spontaneously disappears or is eliminated by means of Bromocriptinum or other means stimulating dopaminergic receptors of a hypothalamus.

The allocations which are not containing milk

The allocations from a nipple which are not containing milk usually indicate high-quality character of a disease. Statement of the correct diagnosis in this case requires careful inspection of the patient. Basic diseases of mammary glands at which sick allocations from a nipple disturb are the cystous mastopathy, expansion of channels, an intra pro-current papillomatosis and cancer. If to judge by specially picked up groups of patients with allocations from a nipple, the quantity of malignant new growths makes 10% and more. However the most part of such messages suffers from tendentiousness as they come or from the institutions specializing in a cancer therapy or contain the information about patients with explicit tumors of a mammary gland at which allocations from a nipple were observed. If to include also large number of the women with allocations from a nipple receiving treatment only at the therapist in this group, then cancer frequency as the reason of allocations will make less than 1%. Therefore it is not necessary to be engaged in hyper diagnosis and hyper therapy, it is always just necessary to remember a possibility of cancer and to carefully inspect each patient
with allocations from a nipple completely to exclude this diagnosis.

Purulent discharges

The real purulent discharges from the nipple are usually atypical. Muddy, dense allocations from a nipple, as a rule, contain not pus, but the thickened decomposition products of cells which are formed at expansion of milk channels. Release of pus more often happens considerably at edge of an areola where the drainage opening of the epithelized chronic abscess of the small size usually is located. In any place of a mammary gland, is more often in a fold under a breast, there can be adenomas of sebaceous glands which are infected, opened and form chronic outside purulent fistulas.

Exudates

As a rule, exudate is emitted from superficial injuries of skin of a mammary gland which differ in nothing from similar damages of other localization. A specific place is held by Pedzhet's illness at which integrity of an epithelium of a nipple owing to an invasion is broken by malignant cells and exudate is emitted with all surface of a nipple. The main tumor, usually intra pro-current cancer, sometimes it is clinically difficult to find.



 
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