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LEARNING OBJECTIVES

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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

  • GERD

  • Seasonal allergies

  • Depression

FH

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.

SH

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).

Meds

  • 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

All

Codeine (hives)

ROS

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

Physical Examination

Gen

The patient is a WDWN white woman in NAD

VS

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

Skin

Normal, intact, warm, and dry

HEENT

PERRLA, EOMI, normal funduscopic exam, normal visual fields

Neck/Lymph Nodes

Normal thyroid, no lymphadenopathy

Lungs/Chest

CTA & P

Breasts

Galactorrhea of left breast, no masses

CV

RRR, ...

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