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  #1  
Old 04-19-2010
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ObGyn Amenorrhea Treatment

A 32-year-old woman comes to the physician because of amenorrhea. She had menarche at age 13 and has had normal periods since then. However, her last menstrual period was 8 months ago. She also complains of an occasional milky nipple discharge. She has no medical problems and takes no medications. She is particularly concerned because she would like to become pregnant as soon as possible. Examination shows a whitish nipple discharge bilaterally, but the rest of the examination is unremarkable. Urine human chorionic gonadotropin (hCG) is negative. Thyroid stimulating hormone (TSH) is normal. Prolactin is elevated. Head MRI scan is unremarkable. Which of the following is the most appropriate pharmacotherapy?

A. Bromocriptine
B. Dicloxacillin
C. Magnesium sulfate
D. Oral contraceptive pill (OCP)
E. Thyroxine
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Old 04-19-2010
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i think it is A. Bromocriptine as it is dopamine agonist that inhibit prolactin release
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Old 04-20-2010
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A. bromocriptin
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Old 04-25-2010
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Warning! ?!?!

I was reading the Kaplan surgery notes and remembered this question.
concerning the prolactinomas...and i quote " therapy with Bromocriptin is used in most cases. Transnasal, trans-sphenoidal surgical removal is reserved for those who wish to get pregnant, or those who fail to respond to bromocriptine."

I looked up if bromocriptine affects pregnancy and couldnt find anything...
anyone got a clue here?

and if bromocriptine really affects pregnancy.. what is the answer to the question.
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Old 04-25-2010
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yes of course treatment of acase of hyperprolactinemia , this treatment (bromocriptin ) should be stoped befor time of expected ovulation ,why ? as they found that in some researches prolactine is needed in blastocyst implantation . look at this http://www.biolreprod.org/content/40/2/232.abstract
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Old 04-25-2010
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Idea! Re: why not bromocriptine in pregnancy

Quote:
Originally Posted by snoureldine View Post
I looked up if bromocriptine affects pregnancy and couldnt find anything...
anyone got a clue here? and if bromocriptine really affects pregnancy.. what is the answer to the question.
The issue here is not that bromocriptine is going to cause infertility. No. It's because surgery is far more effective in treating the hyperprolactinemia than bromocriptine.

Hyperprolactinemia causes infertility, because prolactin has inhibitory action on GnRH and thereby decreasing LH FSH and causing hypogonadtropic hypogonadism.
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