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.
If the above discussed patient did not desire to conceive, how long will she be on dopamine agonist therapy?
The minimal length of dopamine agonist therapy should be 1 year. Some patients may remain in long-term remission after a period of dopamine agonist treatment. If a patient has normal. PRL levels after therapy with dopamine agonists for at least 3 years and the tumor volume is markedly reduced, an attempt at tapering of drugs may be initiated. Patients need to be followed to detect recurrence of hyperprolactinemia and tumor enlargement so that treatment can be promptly resumed.
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