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May 18, 2024

A 35-year-old female complains of a white-colored discharge from her nipples. Upon further questioning, she admits that she has not had her period for the past six months and she has found herself tripping more often in her apartment. On physical examination, it is noted that her peripheral vision is impaired. What medical therapy would most likely help with her symptoms?

Correct Answer: 

A. Bromocriptine

Explanation:

This patient is most likely suffering from a prolactinoma. Hypersecretion of prolactin can stimulate galactorrhea which causes the milky discharge from nipples, suppression of ovulation, and infertility. In addition, since this tumor is located in the pituitary, if the tumor is large enough, it can press on the optic chiasm and cause bitemporal hemianopsia (loss of peripheral vision). Prolactin secretion is suppressed by dopamine and bromocriptine which is a dopamine analog.

Leuprolide (choice B) is a GnRH analog that can be used to suppress the hypothalamic-pituitary axis in conditions such as prostate cancer. Levothyroxine (choice C) is a synthetic analog of T4 (thyroid hormone) which is used in hypothyroidism. Although galactorrhea and anovulation can be seen in severe hypothyroidism (since TRH can also stimulate prolactin), hypothyroidism would not cause loss of peripheral vision. Prednisone (choice D) is a glucocorticoid and used for many purposes but not generally in the case of a prolactinoma. PTU (choice E) is used in hyperthyroidism to suppress thyroid function.

Quick Concepts:

A prolactinoma can be treated with bromocriptine.

Summary:

Hypersecretion of prolactin can stimulate galactorrhea which causes the milky discharge from nipples, suppression of ovulation, and infertility. In addition, since this tumor is located in the pituitary, if the tumor is large enough, it can press on the optic chiasm and cause bitemporal hemianopsia (loss of peripheral vision). Prolactin secretion is suppressed by dopamine and bromocriptine which is a dopamine analog.

Explanation:



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