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Problem: Sutapa, 18 years old, attends her GP clinic complaining of amenorrhoea. She tells a physician that her menarche occurred at the age of 13 and her periods have been regular until 9 months prior to her presentation, when they became less frequent (every 6-7 weeks) and subsequently stopped altogether over 5 months ago. She had three pregnancy tests (most recent a week ago) and they were all negative.
Sutapa denies any change in lifestyle or weight, and she is not having any major stress in her life. However, she mentions galactorrhoea that is becoming an embarrassing problem. Sutapa has normal visual fields and no signs to suggest pituitary failure. Galactorrhoea is confirmed on physical examination. Plasma prolactin is 14 600 mU/L (normal range <600 mU/L). MRI of the pituitary shows a large pituitary adenoma measuring 1.8 cm in diameter with no optic nerve compression. Sutapa comes to see the physician 8 months after starting cabergoline treatment to tell that she is now pregnant.
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