A 35-Year-Old Soldier With Galactorrhea and Amenorrhea

Ranjodh Singh Gill, MD

Disclosures

May 24, 2021

Physical Examination and Workup

The patient appears her stated age and is in no acute distress. Her weight is 145 lb (65.8 kg), her height is 5 ft 6 in (167.6 cm), and her body mass index (BMI) is 23.4 kg/m2.

The patient's heart rate is 64 beats/min, her blood pressure is 115/88 mm Hg, and her respiration rate is 14 breaths/min. Her temperature is 98.1°F (36.7°C).

The following physical examination findings are noted:

  • Dry skin with no scales (Figure 1 shows similar dry skin in a different patient)

  • Normal visual fields by confrontation

  • Bilateral loss of the distal one third of the eyebrows

  • Mild periorbital puffiness but no exophthalmos, lid lag, or stare

Figure 1.

Results of the heart and lung examination are normal. Results of the abdominal examination are also unremarkable, with normal bowel sounds.

The deep tendon reflex at the Achilles tendon is normal in contraction, but the relaxation phase is mildly prolonged. Other deep tendon reflexes are normal.

Results of a chemistry panel and a complete blood cell count are normal. Further laboratory investigations reveal the following values:

  • Total cholesterol level: 221 mg/dL (baseline level, 153 mg/dL; reference range, ≤ 200 mg/dL)

  • Thyroid-stimulating hormone (TSH) level: 188 mIU/L (reference range, 0.358-3.74 mIU/L)

  • Free thyroxine (FT4) level: 0.21 ng/dL (reference range, 0.76-1.46 ng/dL)

  • Anti–thyroid peroxidase (TPO) antibody titer: very high (reference range, < 35 IU/mL)

  • Serum human chorionic gonadotropin level: negative (reference range, < 3 mIU/mL [nonpregnant females])

  • Prolactin level: 94 ng/mL (reference range, < 25 ng/mL [nonpregnant females])

Levels of insulin-like growth factor 1, morning cortisol (8 AM), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) are normal.

Pituitary MRI with and without contrast reveals a 9-mm mass in the sella turcica, with no stalk deviation or compression of the optic chiasm. Similar MRI findings in a different patient are shown below (Figure 2).

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