Question

QUESTION 2 A 46yr old female presents to her ob-gyn with irregular menstruation, galactorrhea and headaches. On questioning, she does not report any hot flashes, changes to mood. Her biochemical testing shows: Fasting glucose: 87 mg/dL (< 100 mg/dL) Cortisol: 15 mcg/dL ( 10-20 mcg/dL) Prolactin: 350 ng/mL (<25 ng/ml Estradiol: 60 pg/mL (15-300pg/mL) a) What is the likely diagnosis? b) What would be a confirmatory test for this diagnosis? c) How does the diagnosis explain the galactorrhea and visual impairment? d) What are some other causes of higher than normal prolactin levels? How likely are they to be responsible for this patient's symptoms? e) Explain why surgery or dopamine agonist treatment is likely to be effective for this patient.

Answer 1

Answer:

a).The most likely diagnosis of this patient is Prolactinoma. It is a benign tumor of the pituitary gland.

b).If the prolactin level is high, the doctor will suggest for a MRI scan to confirm the diagnosis and determine the size and location.

c).Galactorrhea is the milky discharge from one or both breast. Excessive breast stimulation,side effects of medication or pituitary gland disorders also cause galactorrhea.

Pituitary tumors pushes optic chiasm which leads to the vision loss . It can also weaken the optic muscles and causes double vision.

d).* physical stress

* Medication

*Food pattern

* Nipple stimulation

* Other pituitary tumors

*Seizures

This patient has the symptoms of Prolactinoma. The patient might have stress and using any medication or had undergone for any hormonal replacement therapy or pituitary tumors.

e).The treatment methods used for Prolactinoma are dopamine agonists and surgery. Dopamine agonists helps to control the prolactin levels and to shrink the tumor. Bromocriptine and cabergoline are most commonly used drug. It mimics the dopamine effects in the brain.

In patient who can't tolerate the medication , the next option is surgery. There are two surgical procedures - transsphenoidal surgery, transcranial surgery to remove the brain tumor.