Case 1 History Chief complaint and History of Present Illness A 30 year old married lady came to a general practitioner with the chief complaint of bilateral expression of milk from her breasts most of the time over the past few months. She also hasn't had her period since then. It started insidiously. She also noticed doubled vision from time to time. Past Medical History She suffered some gastric discomfort with nausea about six months before the present illness while she is trying for an international examination which was quite stressful for her. She went to a surgeon who prescribed her domperidone for 3 continuous months. Obstetric and Gynaecological History She's been married for 3 years and yet had not children. She did not have periods for about six months. Drug History No other drugs being taken apart from omeprazole 1 b.d. and domperidone 1 t.d.s. No known drug allergy. She has never taken any contraceptives. Physical Examination All system: NAD except expressible breast mild from both sides. Expressed milk appears to be normal with no pus, blood or exudative materials. No breast tenderness. Routine visual examination shows no abnormality at the time of examination. Investigation serum prolactin level (fasting): 250 ng/mL Others: NAD CT/MRI (Head): ? Management Stop Domperidone Initiate: Bromocriptine (Dopamine receptor agonist) Recheck serum prolactin level and continue p.r.n. (probably 12 - 24 months) Explanation about the possibility of relapse Case 2 History A 38 year old male, residing at a remote area in Middle Myanmar, was reported by a journalist for his abnormally high stature. He noticed he became significantly taller than his playmates in his teenage. Around 25 years of age, he noticed his facial profile change with prominent eyebrow, cheek bones and chin. His tongue also enlarged
Case 1 History Chief complaint and History of Present Illness A 30 year old married lady came to a general practitioner with the chief complaint of bilateral expression of milk from her breasts most of the time over the past few months. She also hasn't had her period since then. It started insidiously. She also noticed doubled vision from time to time. Past Medical History She suffered some gastric discomfort with nausea about six months before the present illness while she is trying for an international examination which was quite stressful for her. She went to a surgeon who prescribed her domperidone for 3 continuous months. Obstetric and Gynaecological History She's been married for 3 years and yet had not children. She did not have periods for about six months. Drug History No other drugs being taken apart from omeprazole 1 b.d. and domperidone 1 t.d.s. No known drug allergy. She has never taken any contraceptives. Physical Examination All system: NAD except expressible breast mild from both sides. Expressed milk appears to be normal with no pus, blood or exudative materials. No breast tenderness. Routine visual examination shows no abnormality at the time of examination. Investigation serum prolactin level (fasting): 250 ng/mL Others: NAD CT/MRI (Head): ? Management Stop Domperidone Initiate: Bromocriptine (Dopamine receptor agonist) Recheck serum prolactin level and continue p.r.n. (probably 12 - 24 months) Explanation about the possibility of relapse Case 2 History A 38 year old male, residing at a remote area in Middle Myanmar, was reported by a journalist for his abnormally high stature. He noticed he became significantly taller than his playmates in his teenage. Around 25 years of age, he noticed his facial profile change with prominent eyebrow, cheek bones and chin. His tongue also enlarged
pbl_endo.docx