A 38 year lady was referred with a five month history of secondary amenorrhea, galactorrhoea, failure to conceive and elevated prolactin levels of 2023 miu/L (reference 102496 miu/L). She could not undertake an MRI scan of the pituitary gland as she was claustrophobic and hence a CT scan was performed which did not show and gross pituitary lesion. Microprolactinoma was diagnosed and she commenced bromocriptine. She had normal white blood cells and neutrophil count prior to treatment. Within a month, she conceived and remained off her bromocriptine during pregnancy and delivered normally. Repeat full blood count was performed during pregnancy after having been off bromocriptine for 3 months and it was entirely normal. She represented nine months postpartum with failure to resume periods, persistent galactorrhoea after having stopped breast feeding and elevated prolactin levels of 1948 miu/L. Bromocriptine was initiated which although improved her symptoms of galactorrhoea and normalized prolactin levels to 375 miu/L, it resulted in low neutrophil count of 1.94 (reference range 2.07.5×10×9 g/l). This was attributed to be the adverse effect of bromocriptine and hence it was switched to Quinagolide. Neutrophil count declined further to 1.77 after eight weeks of treatment. We stopped her treatment for 2 months which resulted in recovery of neutrophilS into the normal range, albeit rising prolactin levels to 2138. Cabergoline was initiated which resulted in low neutrophil count to 1.5 and hence it was stopped. She underwent trasn-sphenoidal adenectomy which resulted in cure with normal post-operative pituitary profile and resumption of periods. Neutropenia is an extremely rare side effect of dopamine agonists and this case serves as a reminder of this adverse drug reaction. Although she did not have absolute neutropenia, it was sufficient to warrant withdrawal of therapy.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.