Answer :
Final answer:
The most appropriate next step in the work-up for this patient is to repeat the prolactin level and then perform a pituitary MRI if the level remains elevated. A prolactinoma is the most common cause of hyperprolactinemia and can present with irregular menses and galactorrhea. Medications, hypothyroidism, and chronic kidney disease are other possible causes that would need to be ruled out.
Explanation:
The most appropriate next step in the work-up for this patient is to repeat the prolactin level to confirm the elevated value.
It is important to rule out a laboratory error or a transient elevation. If the prolactin level remains elevated, the next step is to perform a pituitary MRI to visualize the hypothalamic-pituitary area and look for a pituitary adenoma.
Elevated prolactin levels can cause the symptoms of irregular menses and galactorrhea. Prolactin-secreting pituitary adenoma, also known as a prolactinoma, is the most common cause of hyperprolactinemia. The pituitary MRI will help identify the size and location of the adenoma.
Other causes of hyperprolactinemia include medications such as antipsychotics and antidepressants, hypothyroidism, and chronic kidney disease. However, in this case, the patient's history and physical exam are unremarkable, making a prolactinoma the most likely cause.
