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Answers on p 506.
A 16 year old girl was admitted because of low grade fever, headache, and nuchal rigidity. She complained of galactorrhoea during the preceding year and irregular menstruation since menarche at 13 years old. Physical examination was unremarkable except for the galactorrhoea.
The diagnostic work-up for meningitis was negative. Cranial computed tomography and subsequent magnetic resonance imaging showed a large, possibly cystic, pituitary lesion (fig 1). The laboratory work-up showed a mild elevation of basal prolactin levels, 1.05 IU/l; evaluation of pituitary reserve showed normal thyrotrophin, luteinising hormone, and follicle stimulating hormone responses after stimulation. The α-subunit levels were 0.1 mIU/ml. Mild bilateral superior constriction was found on Goldman visual field examination. There were no findings suggestive of sarcoidosis (normal chest radiography, normal serum angiotensin converting enzyme levels).
What is the differential diagnosis for this patient?
Which specific work-up should the follow up include?