00:01
Let's go on to another case.
00:03
A 28-year old woman is evaluated
for amenhorrhea.
00:06
She stopped taking her
oral contraceptive pill
eight months ago
in order to get pregnant.
00:12
Her menstrual cycle
has not resumed.
00:15
She did have
normal menses
prior to the beginning of oral contraceptives
four years ago.
00:22
She also complains of daily nipple discharge
over the last six weeks.
00:27
Other than the oral contraceptive pill,
she takes no other medications.
00:31
On exam,
her vital signs are normal,
but she has a white discharge
from bilateral nipples.
00:38
Her thyroid, skin,
and visual field exam are normal.
00:42
Labs are significant for a prolactin level
of 86 nanograms per ml,
a normal thyroid-stimulating hormone,
and a negative pregnancy test.
00:53
The MRI for pituitary shows
a nine millimeter pituitary mass.
00:58
What is the diagnosis?
This young woman has
secondary amenhorrhea,
the production of abnormal breast milk
or galactorrhea,
an elevated prolactin levels,
and a pituitary mass.
01:12
She most likely has a prolactinoma
in her anterior pituitary
causing secondary amenhorrhea,
which is the cessation of menses,
despite the presence of
normal cycles after puberty.
01:23
Pituitary microadenomas that secrete
excessive prolactin
cause secondary amenhorrhea
due to the inhibition
of gonadotropin-releasing hormone
in the hypothalamus.
01:34
We would treat these patients
with dopamine agonists.
01:37
Bromocriptine is a good first-line agent
because of its low cost.
01:41
Cabergoline is better tolerated
however
because tumor shrinkage is better,
but unfortunately, it is more expensive.
01:50
Always check response to therapy
by repeating a prolactin level
in one month
after commencing treatment.