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therapy is only reserved for nonsurgical candidates, patients who fail to respond to surgery, or cases where complete resection is not possible [8]. Patients have to be counseled about the risks of hypopituitarism either with surgery or radiation treatment.
In conclusion, this young patient presents with classic symptoms of hyperprolactinemia due to a pituitary microadenoma. Generally, the diagnosis for elevated prolactin levels is straightforward and treatment is largely successful. However, it is important as reproductive physicians that the full clinical and pathological relevance of hyperprolactinemia is considered before treatment begins.
References
1.\ Freeman ME, Kanyicska B, Lerant A, Nagy G. Prolactin: structure, function, and regulation of secretion. Physiol Rev. 2000;80(4):1523–631.
2.\ Tolis G, Somma M, Van Campenhout J, Freisen H. Prolactin secretion in sixtyve patients with galactorrhea. Am J Obstet Gynecol. 1974;118(1):91–101.
3.\ Taylor HS, Lubna P, Seli E. Amenorrhea. In: Speroff’s clinical gynecologic endocrinology and infertility. 9th ed. Philadelphia, PA: Wolters Kluwer; 2020. p. 343–94.
4.\ Minakami H, Abe N, Oka N, Kimura K, Tamura T, Tamada T. Prolactin release in polycystic ovarian syndrome. Endocrinol Jpn. 1988;35(2):303–10.
5.\ Melmed S, Jameson JL. Disorders of the anterior pituitary and hypothalamus. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s principles of internal medicine. 16th ed. New York, NY: McGraw Hill; 2008. p. 2076–97.
6.\ Essais O, Bouguerra R, Hamzaoui J, Marrakchi Z, Hadjri S, Chamakhi DS, et al. Ef cacy and safety of bromocriptine in the treatment of macroprolactinomas. Ann Endocrinol (Paris). 2002;63:524–31.
7.\ Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol. 2006;65(2):265–73.
8.\ Tsagaraki S, Grossman A, Plowman PN, Jones AE, Touzel R, Rees LH, et al. Magavoltage pituitary irradiation in the management of prolactinomas: long-term follow-up. Clin Endocrinol. 1991;34(5):399–406.
Chapter 12
Thyroid and Reproduction
Melissa D. Katz
Case
Alicia is a 39-year-old woman with primary infertility and borderline thyroid function tests (TFTs). She has tried to conceive unsuccessfully for the past 18 months and is considering undergoing assisted reproduction. There is no signi cant past medical history with the exception of psoriasis, which has been treated exclusively with topical preparations. Otherwise, she is taking prenatal vitamins daily. Menarche occurred at age 13, and although she took oral contraceptives pills (OCP) from her early 20s until a year and a half ago, she recalls having regular monthly menstrual cycles when she was not on OCP. Her family history is signi cant for hypertension in both parents and systemic lupus erythematosis in her sister. She feels well and denies fatigue or any recent change in weight, bowel function, and temperature tolerance.
On examination, she is a well appearing woman and except for a few psoriatic patches on her elbows and palms, her examination is unremarkable otherwise. Her thyroid gland is not enlarged, tender, or nodular. Two weeks ago, her thyrotropin (TSH) was 4.09 mIU/L (0.55–4.78 mIU/L) with a free T4 of 1.2 ng/dL (0.9–1.8 ng/ dL). A more recent thyroid test pro le revealed a TSH of 4.62 mIU/L with a free T4 of 1.1 ng/dL.
Subclinical hypothyroidism was diagnosed. Her psoriasis and infertility certainly qualify her as a candidate for screening for hypothyroidism. Further testing demonstrated positive thyroid peroxidase (TPO) antibodies. Given her desire to conceive, every effort to normalize her thyroid function is important. Therefore Alicia was started on 50 μg levothyroxine per day aiming for a TSH <2.5 mIU/L which is the rst trimester-speci c normal range.
M. D. Katz (*)
Department of Medicine, Division of Endocrinology, Weill Medical College of Cornell University, New York, NY, USA
e-mail: mdkatz@med.cornell.edu
© Springer Nature Switzerland AG 2023 |
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P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_12
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