A 29-year-old lady comes to the hospital for complaints of oligomenorrhea for past 3 years. She attained menarche at 14 years and has had regular cycles since then. Over the last three years, she has gained 8–9 kilos of weight gradually. She has no complaints suggestive of galactorrhea, hot flashes or symptoms suggestive of thyroid dysfunction. She has been married for 3 years and wants to plan a pregnancy soon. Her last menstrual period was 15 days ago. She suffers from dyspepsia for which she uses pantoprazole and domperidone tablets 4–5 times a week. Her family has a history of thyroid dysfunction. On examination, she has a body mass index of 28.5 kg/m2. On general examination, she has grade 2 goiter, acanthosis, modified Ferriman–Gallwey score of 12/36 and expressive galactorrhea unnoticed before. Clinical examina- tion is not suggestive of any other illness like hypothyroidism or thyrotoxicosis, Cushing’s syndrome or acromegaly. Confrontation test is normal. Skin and ankle jerk normal.
Galactorrhea may be overlooked unless actively elicited.
Laboratory Examination Reveals Thyroid-stimulating hormone (TSH) 2.5 micro IU/L. Total T4 10 mg/dL, prolactin 160 ng/mL, urine pregnancy test negative. Ultrasound pelvis shows ovarian volume 12 cm3 with numerous cysts in both ovaries peripherally. A diagnosis of hyperprolactinemia, probably drug induced is made.
Should we continue dopamine agonist after conception in our patient with microadenoma?
Medicine
Microadenomas have a lesser chance of symptomatic tumor enlargement during pregnancy. Although dopamine agonists especially bromocriptine has been used in pregnancy and no adverse fetal effects have been documented, it is prudent to eliminate risk of fetal exposure to any drug once conception occurs. Hence, in our patient with microadenoma, it is recommended that the dopamine agonist be stopped once the pregnancy test is positive.
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