Breast

Question 1

What are the causes of hyperprolactiniaemic galactorrhoea

Answer 1

Idiopathic

Pituitary tumour

Drug-induced (SSRIs, anti-psychotics, H2 antagonists)

Neurological (inhibition of dopamine, spinal cord injury)

Hypothyroidism (high TRH can stimulate prolactin)

Renal failure

Liver failure

Damage to pituitary stalk

Question 2

What investigations are needed for abnormal galactorrhoea

Answer 2

Exclude pregnancy

Bloods (prolactin, TFTs, LFTs, U&Es)

MRI head (pituitary tumour)

Breast imaging (palpable mass)

Question 3

How is galactorrhoea treated in pituitary tumours

Answer 3

Dopamine agonist therapy (cabergoline, bromocriptine)

Question 4

What are the causes of non-cyclical mastalgia

Answer 4

Medications (hormonal contraceptives, sertraline, haloperidol)

Question 5

What is the medical management for mastalgia that does not settle with first line methods and analgesia

Answer 5

Danazol (anti-gonadotropin agent)

Question 6

What are the physiological causes of gynaecomastia

Answer 6

Delayed testosterone surge (in adolescence)

Decreased testosterone (in elderly)

Question 7

What are the pathological causes of gynaecomastia

Answer 7

Lack of testosterone (Kleinfelter’s syndrome, androgen insensitivity, testicular atrophy…)

Increased oestrogen (liver disease, hyperthyroidism, obesity, adrenal tumours)

Medications (digoxin, metronidazole, spironolactone, antipsychotics, chemotherapy)

Question 8

What investigations are needed for gynaecomastia

Answer 8

Bloods (LH testosterone balance)

Triple assessment (if suspect malignancy)