Young woman with galactorrhoea
A 33-year-old woman was referred to endocrinology outpatient for preoperative evaluation of a pituitary tumour and galactorrhoea. She was asymptomatic one and a half years ago when she developed bilateral galactorrhoea. She was on oral contraceptive pills (ethinyloestradiol and gestodene) for last two and a half years. She had no other complaints. Menarche was at the age of 15 years. Clinically she was found to be normal, except for bilateral expressive galactorrhoea. Serum prolactin levels were 45 micrograms per litre , and Magnetic resonance imaging was reported to have a 10-millimeter size pituitary tumour.
In endocrinology Outpatient her general physical examination, pulse rate, blood pressure, skin, voice, visual fields, fundi, cranial nerves were normal. There was no goitre. She had bilateral expressive galactorrhoea. The ankle jerks showed a delayed relaxation phase. Her haematological parameters, serum cholesterol, chest X-ray and Electrocardiogram were normal. The serum prolactin was 166 micrograms per litre . The serum Thyroid stimulating hormone was 432 miliUnits per litre , Triiodothyronine 2 picomolecules per litre , Thyroxine 4 picomolecules per litre . The thyroid peroxidase antibodies were positive. The sella Magnetic resonance imaging revealed sellar enlargement consistent with pituitary hyperplasia (13 multiplied by 11 millimeteres) with suprasellar extension. There was no focal lesion. A diagnosis of primary hypothyroidism (due to autoimmune thyroid disease) leading to pituitary hyperplasia, and presenting with galactorrhoea was made. She was placed on thyroid hormone replacement therapy in gradually increasing doses to 150 micrograms per day. Oral contraceptive pills were stopped. Three months later the galactorrhoea had subsided, and regular menstrual cycles commenced. Four months after initiation of thyroid hormone replacement therapy the prolactin levels, Triiodothyronine, Thyroxine, Thyroid stimulating hormone was normal. A repeat Magnetic resonance imaging of sellar region revealed a normal sized pituitary and sella.