A 24-year-old woman is evaluated for 3 months of galactorrhea, worsening fatigue, and malaise. She was well 6 months ago and without explanation began feeling tired and lethargic. She has noted milk leaking spontaneously from her breasts. Her menses have been unpredictable. She had a normal cycle 3 months ago and 4 months ago, but then her next cycle was delayed. Her last menstrual period was 6 weeks ago, and she had excessive bleeding. She has stopped exercising and has gained 3.6 kg (8 lb). She also reports headaches that occur about 2 to 3 times per week. She has noted constipation and breast tenderness. She has no libido, which is a significant change. She took a home pregnancy test, which was negative. She has a history of depression. There is no family history of pituitary disease. Her only medication is sertraline for depression.
On physical examination, her temperature is 37.2 °C (99.0 °F), blood pressure is 118/68 mm Hg, pulse rate is 72/min, and respiration rate is 10/min. BMI is 28. Otherwise, her physical examination is unremarkable.
Human chorionic gonadotropin | Negative |
Prolactin | 68 ng/mL (68 µg/L) |
Thyroid-stimulating hormone | 15 µU/mL (15 mU/L) |
Thyroxine (T4), free | 0.82 ng/dL (10.6 pmol/L) |
Which of the following is the most appropriate management?