Twenty Year-old Woman with Amenorrhea and Lactorrhea CASE 5 Twenty Year-old Woman with Amenorrhea and Lactorrhea

L. B. is a 20-year-old college student with amenorrhea L.B. is a 20-year-old college student with amenorrhea. She had normal menarche and thelarche, but when she went to college at the age of 18 her menses became irregular and ultimately stopped completely when she was 19. She was otherwise healthy, and participated actively in intramural athletics including basketball. She had a history of classic migraine headaches, but had noted no persistent visual disturbance. She had a fracture of her right ankle one year earlier when stepping off a curb.

On examination, she had a normal body habitus, and vital signs were normal. Breasts were Tanner stage III, and a small amount of milky fluid could be expressed bilaterally during the exam. Skin and deep tendon reflexes were normal. Visual fields were tested formally and were normal.

Lab Data: Routine hematology and chemistry tests - normal Endocrine studies included: Total T4 4.6-12 ug/dl Free T4 1.4 ng/dl TSH 1.0 uU/ml  LH 5.4 mU/ml FSH 4.0 mU/ml Estradiol within normal limits  Prolactin 129 ng/ml (reference range 0-17 ng/ml)  X-ray see

CT scan of sella pituitary asymmetry R>L distortion and erosion of floor

Pituitary Prolactinoma She has transsphenoidal surgery. Her recovery was uneventful except for mild transient diabetes insipidus which occurred on the day following surgery and required treatment with a single dose of subcutaneous DDAVP. On follow up evaluation, menses had returned, galactorrhea had ceased, and her serum prolactin has fallen to 11 ng/ml. The biopsy material showed the followinng