Approach to nipple discharge Quiz: Ace Your Exams

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A 35-year-old woman is evaluated for a month-long history of bilateral milky nipple discharge. Review of systems is significant for 2 months of constipation and weight gain of 3.0 kg (6.6 lbs). Her menstrual cycles have become irregular recently. Her most recent menstrual period was 4 weeks ago. She completed breastfeeding her infant 6 months ago and is currently not taking any medications. Temperature is 37.0°C (98.6°F), pulse is 50/min, respirations are 15/min, and blood pressure is 135/85 mmHg. BMI is 28. On physical examination, a small amount of bilateral milky discharge is expressed with palpation of  the areola. Visual fields are intact. Deep tendon reflexes are delayed. The remainder of the physical examination is normal. Human chorionic gonadotropin testing is negative. Serum prolactin level is 78 ng/mL (78 μg/L). A brain MRI is negative. Which of the following is the most appropriate next step in the evaluation?

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