A 36 years old female came to see the doctor with the complaint of amenorrhea (absence of menstrual period) for past three months. She is worried if she is pregnant although she never missed her Contraceptive Pills. She recently noticed some milky discharge from her left breast and abnormal facial hairs. She also said that her period was irregular and less in amount for past one year. She also gained 15 pounds during last year but denies any cold intolerance, dry skin, depression, fatigue or hot flushes. Her menarche was at 14 and she had regular 21 days cycle till last year when it became irregular and gradually scanty.
Her LMP (last menstrual period) was 3 months back.
She has a 10 years old healthy child (normal vaginal delivery). She has regular Pap test, last test was done 10 months ago which was normal.
Her mother had menopause at age 55.
Her vitals were normal.
Her pregnancy test was done at the office which was Negative.
The doctor reassured and discussed hormonal imbalances with her. She recommended her urine and blood tests for hormone levels and pelvic ultrasound to check her reproductive organs. The doctor advised her to come back with all the test result

1. After reading given case, what will be the most likely diagnosis of this patient?
2. Normal woman does not show and breast discharge, what could be the reason in this patient for breast discharge?

Help me answer to your best of ability

The correct answer is -

1. galactorrhea or prolactinoma

2. hormonal imbalance (prolactin imbalance)

Explanation:

The given symptoms experienced by the patient are the absence of menstrual cycles, an increase in weight, some milky discharge from her left breast, and abnormal facial hairs. The pregnancy tests show she is not pregnant and she also does not experience cold intolerance, dry skin, depression, fatigue or hot flushes.

All these suggest that there is a hormonal imbalance in her and due to producing a white substance from the breast it can get that there is too much production of prolactin, which suppresses the effect of estrogen, which is producing by the pituitary gland.

Galactorrhea or prolactinoma are two disorders that affect the production of prolactin that cause milky discharge, it can be caused by overuse of contraceptives or underlying conditions.

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