Female with secondary amenorrhea with serum prolactin level 75 ng/ml is to be treated with ?
**Core Concept**
The patient presents with secondary amenorrhea, which is a common symptom of hyperprolactinemia. Elevated serum prolactin levels (hyperprolactinemia) can disrupt the normal hypothalamic-pituitary-ovarian axis, leading to menstrual irregularities and infertility. Dopamine is the primary neurotransmitter that inhibits prolactin secretion from the pituitary gland.
**Why the Correct Answer is Right**
The treatment of choice for this patient is a dopamine agonist, which mimics the action of dopamine to inhibit prolactin secretion. Bromocriptine (A) is a first-generation dopamine agonist that has been widely used to treat hyperprolactinemia. It acts by binding to dopamine receptors in the pituitary gland, thereby reducing prolactin secretion and normalizing menstrual function. Other options, such as estrogen replacement therapy (Option B), would not address the underlying cause of hyperprolactinemia and may even worsen the condition. Cabergoline (Option C) is a second-generation dopamine agonist with a longer half-life and fewer side effects, but it is not the first-line treatment for hyperprolactinemia. Metoclopramide (Option D) is a dopamine antagonist, which would actually worsen hyperprolactinemia.
**Why Each Wrong Option is Incorrect**
**Option B:** Estrogen replacement therapy would not address the underlying cause of hyperprolactinemia and may even worsen the condition by increasing prolactin levels.
**Option C:** Cabergoline is a second-generation dopamine agonist, but it is not the first-line treatment for hyperprolactinemia.
**Option D:** Metoclopramide is a dopamine antagonist, which would actually worsen hyperprolactinemia by increasing prolactin levels.
**Clinical Pearl / High-Yield Fact**
Dopamine agonists, such as bromocriptine, are the first-line treatment for hyperprolactinemia, and they can also be used to treat other conditions such as acromegaly and Parkinson's disease.
**Correct Answer:** A. Bromocriptine.