Hyperprolactinemia Patient Encounter 2 Medical History Physical Examination and Diagnostic Tests

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WB, a 27-year-old woman, presents to the Women's Health Clinic. Her chief complaint is milky fluid discharge from both breasts. WB also mentions that her menstrual periods have stopped since she stopped taking her oral contraceptive 8 months ago with the hope of conceiving. Her menstrual cycle was regular before starting the oral contraceptive. WB does not have recent weight change, excessive hair growth, or acne. She also does not exercise excessively and is otherwise healthy. She took a home pregnancy test 1 week ago, which was negative.

PMH: None

FM: Both parents are still alive and healthy.

SH: Married, works as a high school teacher, and is physically active (walks 3 miles twice a week)

Meds: NuvaRing use as directed (discontinued 8 months ago); acetaminophen 325 mg two tablets every 4 to 6 hours as needed for mild headaches

ROS: Negative, other than in history of present illness.

HEENT: Ophthalmic examination reveals normal visual acuity and fields. (-) goiter

VS: BP 100/62 mm Hg, P 82 bpm, RR 18 breaths/min, T 37.1°C (98.8°F)

CV: RRR, normal S1, S2; no murmurs, rubs, or gallops

Breasts: (+) bilateral expressible galactorrhea with no other abnormality

Abd: Soft, nontender, nondistended; (+) bowel sounds; no hepatosplenomegaly

Labs: Electrolytes, renal and thyroid function, FSH, LH, and testosterone are within normal limits. Elevated prolactin at 115 ng/mL (115 mcg/L). Pregnancy test is negative.

Imaging: MRI reveals a pituitary tumor approximately 9 mm in diameter.

Given this information, what signs and symptoms does WB have for hyperprolactinemia?

Identify your treatment goals for WB.

What nonpharmacologic and pharmacologic treatment options are available for WB?

Outcome Evaluation

• Assess patients for tolerability to dopamine agonists.

• Monitor clinical symptoms associated with hyperprolactinemia every month for the first 3 months to assess therapeutic efficacy and assist with dose titration.

• Evaluate the patient for symptoms, such as headache, visual disturbances, menstrual cycles in women, and sexual function in men, to assess clinical response to therapy.

• Once the prolactin level is normalized and clinical symptoms of hyperprolactinemia have resolved, monitor prolactin level every 6 to 12 months.42,43

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