Your patient is a 46-year-old woman suffering from psychosis complains of milky discharge from both her breasts. Upon examination, there are no significant findings and the patient is not pregnant, breastfeeding, or in the postpartum period. You should:
A. Order CT scan of head to rule out pituitary tumor
B. Obtain a complete list of the patient's medications
C. Have the patient keep a menstrual cycle diary
D. Refer the patient for mammogram
ANS: B
Galactorrhea is characterized by bilateral and milky discharge from multiple ducts in a woman who is neither pregnant nor lactating. Causes of galactorrhea include a variety of drugs as well as an elevated prolactin level associated with pituitary tumor or hyperthyroidism. The drugs associated with galactorrhea include antidepressants (amitriptyline, imipramine), psychoactives (haloperidol, thioridazine), hormones (estrogens, progestogens), antiepileptics (valproic acid), and antihypertensives (verapamil). This list is not exhaustive.
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