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Alteration of the tuberoinfundibular pathway
25%
1/4
Alteration of the nigrostriatal pathway
50%
2/4
Alteration of the mesolimbic pathway
Prolactin-secreting mass
0%
0/4
Normal pregnancy
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This patient is presenting with new-onset bilateral nipple discharge and amenorrhea in the setting of a recent hospitalization for psychosis. D2 blockade (dopamine receptors) of the tuberoinfundibular pathway is the likely cause of these symptoms. Psychosis is typically treated with medications that block D2 receptors in the mesolimbic pathway. A side-effect of these medications is D2 blockade in the tuberoinfundibular pathway. Dopamine inhibits prolactin release; when these receptors are blocked, prolactin is released in increased amounts. Increased prolactin can cause bilateral milky nipple discharge and amenorrhea. Incorrect Answers: Answer 2: Alteration of the nigrostriatal pathway from D2 blockade can induce Parkinsonian symptoms. Answer 3: Alteration of the mesolimbic pathway from D2 blockade is the therapeutic mechanism of action of antipsychotics. Answer 4: Prolactin-secreting mass describes a prolactinoma which could present with these symptoms, in addition to mass effects such as bitemporal hemianopsia from compression of the optic chiasm. Answer 5: Normal pregnancy is a possible diagnosis; however, bilateral nipple discharge is less likely to occur in a patient who has only missed one menstrual period. Given her recent hospitalization for psychosis, medication-induced symptoms are more likely. Bullet Summary: A side-effect of antipsychotics is bilateral nipple discharge and amenorrhea which occurs secondary to D2 blockade in the tuberoinfundibular pathway.
4.8
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