06-20-2011, 11:38 AM
1. A 28-year-old woman, whose method of contraception is con-
doms, complains of secondary amenorrhea for the past 6 months.
She does not “feel pregnant” and an over-the-counter pregnan-
cy test was negative after 3 months. She has noticed a small
amount of white discharge from both nipples, although not
enough to dampen her undergarments. There are no other
symptoms of pituitary insufficiency and no neurologic symptoms.
She takes no prescription medication but used marijuana occa-
sionally during college. On examination, there is evidence of an
upper, outer quadrantanopia, most prominent on the right. The
pulse is 78 beats per minute and the blood pressure is 102/64 mm
Hg. There is expressible white discharge from both breasts. CT
scan of the head reveals a 1.5-cm pituitary mass, which distorts
the optic chiasm. Laboratory data include the following: morn-
ing cortisol 22 mcg/dL (reference range, 10-24 mcg/dL), sodi-
um 140 mEq/L, potassium 3.8 mEq/L, free thyroxine 0.6 ng/dL
(reference range, 0.8-1.8 ng/dL), hemoglobin 12.9 g/dL, and
creatinine 1.1 mg/dL. What should you do next?
a. Measure serum prolactin level.
b. Refer her to a neurosurgeon for transsphenoidal surgery.
c. Measure serum thyrotropin (TSH) level.
d. Measure serum insulinlike growth factor 1 (IGF-1) level.
e. Check visual fields.
doms, complains of secondary amenorrhea for the past 6 months.
She does not “feel pregnant” and an over-the-counter pregnan-
cy test was negative after 3 months. She has noticed a small
amount of white discharge from both nipples, although not
enough to dampen her undergarments. There are no other
symptoms of pituitary insufficiency and no neurologic symptoms.
She takes no prescription medication but used marijuana occa-
sionally during college. On examination, there is evidence of an
upper, outer quadrantanopia, most prominent on the right. The
pulse is 78 beats per minute and the blood pressure is 102/64 mm
Hg. There is expressible white discharge from both breasts. CT
scan of the head reveals a 1.5-cm pituitary mass, which distorts
the optic chiasm. Laboratory data include the following: morn-
ing cortisol 22 mcg/dL (reference range, 10-24 mcg/dL), sodi-
um 140 mEq/L, potassium 3.8 mEq/L, free thyroxine 0.6 ng/dL
(reference range, 0.8-1.8 ng/dL), hemoglobin 12.9 g/dL, and
creatinine 1.1 mg/dL. What should you do next?
a. Measure serum prolactin level.
b. Refer her to a neurosurgeon for transsphenoidal surgery.
c. Measure serum thyrotropin (TSH) level.
d. Measure serum insulinlike growth factor 1 (IGF-1) level.
e. Check visual fields.