tailieunhanh - Case lâm sàng sản khoa - Case 1

Tham khảo tài liệu 'case lâm sàng sản khoa - case 1', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 19 A 30-ycar-old parous woman notes a watery breast discharge of 6 months duration. Her menses have been somewhat irregular. She denies a family history of breast cancer. The patient had been treated previously with radioactive iodine for Grave s disease. Currently she is not taking any medications. On examination she appears alert and in good health. The BP is 120 80 and HR is 80 bpm. The breasts are symmetric and without masses. No skin retraction is noted. A white discharge can be expressed from both breasts. No adenopathy is appreciated. The pregnancy test is negative. What is the most likely diagnosis What is your next step 168 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 19 Galactorrhea Due to Hypothyroidism Summary A 30-ycar-old parous woman with irregular menses notes a watery breast discharge of 6 months duration. She had been treated previously with radioactive iodine for Grave s disease. The pregnancy test is negative. Most likely diagnosis Galactorrhea due to hypothyroidism. Next step Check scrum prolactin and TSH levels. Analysis Objectives 1. Know the clinical presentation of galactorrhea. 2. Know some of the major causes of hyperprolactinemia. 3. Understand that hyperprolactinemia can induce hypothalamic dysfunction leading to oligo-ovulation and irregular menses. Considerations This patient complains of oligomenorrhea and a white watery breast discharge which is likely to be milk galactorrhea . The first investigation should be a pregnancy test. Causes of galactorrhea include a pituitary adenoma pregnancy breast stimulation chest wall trauma or hypothyroidism. She does not have headaches or visual disturbances. This woman had been treated previously with radioactive iodine for Grave s disease and is not taking thyroid replacement. Thus she likely has hypothyroidism. With primary hypothyroidism both the thyroid-releasing hormone TRI I and thyroid-stimulating hormone TSH are elevated. TRH acts as a prolactin-releasing hormone. Hence .