After completing this case study, the reader should be able to:
Recognize the signs and symptoms of hyperprolactinemia.
Recommend appropriate treatment options for hyperprolactinemia.
Design a plan to monitor the response to the pharmacologic treatment of hyperprolactinemia.
“I haven’t had my period for almost a year.”
Susan Oliver is a 31-year-old woman with a history of oligomenorrhea (menstrual cycle every 2–6 months) since menarche at age 14. She presents to her gynecologist after 11 months of amenorrhea and a small amount of milky discharge from her left breast, which she first noticed 1–2 months ago. The patient and her husband would like to have a baby, but she is concerned that she may be unable to have children. The patient states that she and her husband have not used birth control for more than 1 year, and she has had several negative home pregnancy tests.
Father died at age 58 from an AMI; mother (age 62) has type 2 DM and HTN. Patient has two brothers (ages 33 and 35) who are alive and well.
The patient is employed as an administrative assistant. She does not smoke and has less than one drink of alcohol per month. She has been married for 5 years and lives with her husband and two stepdaughters (ages 7 and 9).
Omeprazole 20 mg PO daily
Desloratadine 5 mg PO daily
Fluoxetine 20 mg PO daily
Prenatal vitamins one tablet PO daily
Acetaminophen 500 mg PO PRN
Galactorrhea of the left breast and amenorrhea for 11 months as described in the HPI. No visual defects. No active GERD or migraine symptoms.
The patient is a WDWN white woman in NAD
BP 124/71 mm Hg, P 72 bpm, RR 13, T 37.1°C; Wt 72 kg, Ht 5′8″
Normal, intact, warm, and dry
PERRLA, EOMI, normal funduscopic exam, normal visual fields
Normal thyroid, no lymphadenopathy
Galactorrhea of left breast, no masses
RRR, S1 and S2 normal, no MRG
Soft, nontender, no organomegaly, (+) bowel ...