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Old 11-05-2012
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Arrow Gyrus Daily Questions; Obstetrics & Gynecology #10

A 43-year-old woman comes to the physician because of a 6-month history of irregular periods She also has whitish nipple discharge Her last menstrual period was 3 months ago She is sexually active with her husband, and they use condoms consistently She denies vigorous exercise She does not smoke or drink alcohol She takes no medications Her temperature is 37C (98 6F) and her blood pressure is 130/75 mm Hg Breast examination shows no masses, and a moderate amount of whitish discharge is expressed from her nipples Pelvic examination shows no abnormalities Urine human chorionic gonadotropin (hCG) test is negative Serum prolactin level is 40 ng/mL (normal. <20 ng/mL) and serum TSH level is 3 mIU/L. Further laboratory testing is most likely to show which of the following?

A. High antidiuretic hormone (ADH)
B. High luteinizing hormone (LH)
C. Low adrenocorticotropic hormone (ACTH)
D. Low follicle-stimulating hormone (FSH)
E. Low growth hormone (GH)
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D. Low follicle-stimulating hormone (FSH)
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Originally Posted by cingulate.gyrus View Post
A 43-year-old woman comes to the physician because of a 6-month history of irregular periods She also has whitish nipple discharge Her last menstrual period was 3 months ago She is sexually active with her husband, and they use condoms consistently She denies vigorous exercise She does not smoke or drink alcohol She takes no medications Her temperature is 37C (98 6F) and her blood pressure is 130/75 mm Hg Breast examination shows no masses, and a moderate amount of whitish discharge is expressed from her nipples Pelvic examination shows no abnormalities Urine human chorionic gonadotropin (hCG) test is negative Serum prolactin level is 40 ng/mL (normal. <20 ng/mL) and serum TSH level is 3 mIU/L. Further laboratory testing is most likely to show which of the following?

A. High antidiuretic hormone (ADH)
B. High luteinizing hormone (LH)
C. Low adrenocorticotropic hormone (ACTH)
D. Low follicle-stimulating hormone (FSH)
E. Low growth hormone (GH)
D prolactin inhibits gonadotropin release.

Remember also hypothyroidism causes hyperprolactinemia via increased TRH which in turn stimulates prolactin release
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D. Low follicle-stimulating hormone (FSH)
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D. Low follicle-stimulating hormone (FSH)

The patient described has amenorrhea and galactorrhea caused by an elevated prolacfin level

Hyperprolacfinemia can be primary or secondary

Primary hyperprolacfinemia is caused by a prolacfin-secreting dominant adenoma. the most frequent functional adenoma of the pituitary gland (-50% of all pituitary adenomas)

Excess prolacfin causes suppression of gonadotropin-releasing hormone (GnRH). whose pulsatile secretion is responsible for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion from the pituitary gland Suppression of GnRH by prolacfin thus causes low LH levels (compare with choice B) and low FSH levels In the absence of these hormones. amenorrhea ensues, because the follicular cycle does not proceed

This patient's TSH level is normal, indicating that hypothyroidism. a common cause of secondary hyperprolactinemia. is not the cause of this patient's condition

High antidiuretic hormone (ADH) (choice A) would be seen in the syndrome of inappropriate antidiuretic hormone (SIADH). which causes symptoms of headache. irritability, confusion, muscle cramps. weakness. obtundation. seizures, and coma caused by the hyponatremia

If a prolacfin adenoma becomes large enough. it may cause panhypopituitarism. and then the other pituitary hormones may be affected

Low adrenocorticotropic hormone (ACTH) (choice C) causes adrenal insufficiency and subsequent signs and symptoms. including gastrointestinal disturbances. muscle weakness. fatigue. and hypotension Extreme cases of adrenal insufficiency can cause shock

Growth hormone insufficiency (choice E) can cause signs and symptoms of decreased muscle mass and strength. osteoporosis. and insulin resistance.
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