Interactive Quiz: Galactorrhea as the Initial Presentation of a Hepatic Condition

Liver function test results showed a total bilirubin level of 1.2 mg/dL (reference range, 0.3-1.2 mg/dL), an aspartate aminotransferase level of 113 U/L (reference range, 10-42 U/L), an alanine aminotransferase level of 76 U/L (reference range, 10-60 U/L), and an alkaline phosphatase level of 70 U/L (reference range, 32-92 U/L).

Hormonal studies disclosed the following values: estradiol, 46.4 pg/mL (reference range, 7.6-42.6 pg/mL); luteinizing hormone (LH), 29.2 mIU/mL (reference range, 1.7-8.6 mIU/mL); follicle-stimulating hormone (FSH), 33.9 mIU/mL (reference range, 1.3-19.3 mIU/mL); total testosterone, 867 ng/mL (reference range, 348-1197 ng/mL); thyrotropin, 2.27 mIU/L (reference range, 0.34-5.60 mIU/L); and β human chorionic gonadotropin (β-hCG), elevated at 4 mIU/mL (reference range, 0-3 mIU/mL). The prolactin level was normal at 8.22 µg/L (reference range, 2.64-13.13 µg/L).

Results of a comprehensive metabolic panel showed hyponatremia (sodium, 134 mEq/L) with a blood urea nitrogen level of 5 mg/dL. Results of a complete blood cell count were normal. The prothrombin time was 13.1 seconds (reference range, 9.0-12.9 seconds), the international normalized ratio was 1.2 (reference value, ≤ 1.5), and activated partial thromboplastin time was 44.8 seconds (reference range, 23.0-35.0 seconds).

Results of serologic tests for transmissible infections were positive for hepatitis C virus (HCV) antibodies and showed an elevated genotype 1a HCV RNA viral load of 74,490 IU/mL.

What was the patient’s underlying diagnosis?>>