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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • 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.

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PATIENT PRESENTATION

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Chief Complaint

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“I haven’t had my period for almost a year.”

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HPI

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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.

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PMH

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  • GERD

  • Seasonal allergies

  • Depression

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FH

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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.

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SH

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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).

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Meds

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  • 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

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All

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Codeine (hives)

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ROS

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Galactorrhea of the left breast and amenorrhea for 11 months as described in the HPI. No visual defects. No active GERD or migraine symptoms.

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Physical Examination

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Gen
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The patient is a WDWN white woman in NAD

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VS
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BP 124/71 mm Hg, P 72 bpm, RR 13, T 37.1°C; Wt 72 kg, Ht 5′8″

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Skin
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Normal, intact, warm, and dry

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HEENT
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PERRLA, EOMI, normal funduscopic exam, normal visual fields

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Neck/Lymph Nodes
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Normal thyroid, no lymphadenopathy

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Lungs/Chest
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CTA & P

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Breasts
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Galactorrhea of left breast, no masses

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CV
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RRR, S1 and S2 normal, no MRG

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Abd
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Soft, nontender, no organomegaly, (+) bowel ...

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