A 29-year-old woman comes to the office for evaluation of infertility. The patient and her husband have been trying to conceive for the past 2 years but have been unsuccessful. Her husband recently underwent infertility evaluation and was found to have no abnormalities. Menses had previously occurred at regular 28-day intervals with moderate flow. Her last menstrual period was 12 weeks ago. She is sexually active with her husband but reports decreased interest in sexual intercourse over the past few months. The patient does not smoke or drink alcohol. She is 168 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24 kg/m2. She appears uncomfortable. Vital signs are within normal limits. A urine pregnancy test is negative. A pelvic ultrasound shows atrophic endometrium. Neurological examination shows diminished vision in the bilateral temporal visual fields. Examination of the other cranial nerves is normal and there is no focal weakness or sensory loss. An abnormality originating in which of the following is the most likely cause of this patient's current condition?

Question

A 29-year-old woman comes to the office for evaluation of infertility.  The patient and her husband have been trying to conceive for the past 2 years but have been unsuccessful.  Her husband recently underwent infertility evaluation and was found to have no abnormalities.  Menses had previously occurred at regular 28-day intervals with moderate flow. Her last menstrual period was 12 weeks ago. She is sexually active with her husband but reports decreased interest in sexual intercourse over the past few months. The patient does not smoke or drink alcohol. She is 168 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24 kg/m2. She appears uncomfortable. Vital signs are within normal limits. A urine pregnancy test is negative. A pelvic ultrasound shows atrophic endometrium. Neurological examination shows diminished vision in the bilateral temporal visual fields.  Examination of the other cranial nerves is normal and there is no focal weakness or sensory loss.  An abnormality originating in which of the following is the most likely cause of this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Prolactinomas are the most common pituitary adenoma and can cause galactorrhea, menstrual irregularities, and infertility in premenopausal women.  Large pituitary adenomas can cause headaches from mass effect and bitemporal hemianopsia from compression of the optic chiasm.

A 29-Year-Old Woman Comes to the Office for Evaluation of Infertility