Managing High Prolactin Levels: When to Seek a Second Opinion

Prolactin

Hello, doctor.
I have an issue with elevated prolactin levels.
An MRI scan revealed a nearly invisible pituitary tumor.
When I lived in the south, my doctor would regularly draw blood and prescribe medication for me.
After moving to the north and wanting to conceive a second child, I haven't had any news yet.
I have seen a gynecologist, and my uterus is normal.
There was a month when my period didn't come, but it returned afterward.
I have experienced slight headaches a few times.
Recently, I had blood drawn, and my prolactin level was 47.
My attending physician mentioned that this level seems normal and did not prescribe any medication.
I would like to ask if you would recommend seeing another doctor, continuing with the endocrinology department, or switching to obstetrics and gynecology? Thank you.

Narsha, 30~39 year old female. Ask Date: 2018/11/05

Dr. Chen Shunfu reply Internal Medicine

Hello, the normal range for prolactin levels in our hospital is 2.8-29.2 ng/mL, so a level of 47 is still slightly elevated.
It is advisable to follow up with the endocrinology department at a medical center or a large teaching hospital.

Reply Date: 2018/11/05

More Info

Managing high prolactin levels can be a complex issue, especially when it involves the presence of a pituitary adenoma, as in your case. Prolactin is a hormone produced by the pituitary gland, and elevated levels can lead to various symptoms, including galactorrhea (milk production), menstrual irregularities, and infertility. The management of high prolactin levels often requires a multidisciplinary approach, involving endocrinologists, gynecologists, and sometimes neurosurgeons.

Given your situation, where you have a pituitary tumor that is not clearly visible on MRI and elevated prolactin levels (47 ng/mL), it is essential to consider several factors before deciding whether to seek a second opinion or change your healthcare provider.

1. Understanding Prolactin Levels: Normal prolactin levels can vary, but generally, levels above 25 ng/mL are considered elevated. Your level of 47 ng/mL indicates hyperprolactinemia, which typically warrants further investigation and treatment, especially if you are experiencing symptoms like menstrual irregularities or headaches.

2. Pituitary Adenoma Management: The presence of a pituitary adenoma, even if small, can lead to increased prolactin production. Treatment often involves dopamine agonists like cabergoline or bromocriptine, which can help reduce prolactin levels and shrink the tumor. If your current physician has not prescribed medication despite your elevated levels, it may be worth discussing the rationale behind this decision.
3. Consulting Specialists: Since you have already seen an obstetrician-gynecologist who found your uterus normal, it might be beneficial to continue seeing an endocrinologist who specializes in hormonal disorders. They can provide a more focused approach to managing your prolactin levels and the associated symptoms. If you feel that your current endocrinologist is not addressing your concerns adequately, seeking a second opinion from another endocrinologist could provide you with more clarity and options.

4. Symptoms and Monitoring: You mentioned experiencing some headaches and menstrual irregularities. These symptoms can be related to elevated prolactin levels or the pituitary tumor itself. It is crucial to monitor these symptoms closely and communicate them to your healthcare provider. If your symptoms worsen or if you have concerns about your current treatment plan, it is entirely reasonable to seek a second opinion.

5. Fertility Considerations: Since you are trying to conceive, managing your prolactin levels is particularly important. Elevated prolactin can interfere with ovulation and fertility. If your current physician is not taking proactive steps to manage your prolactin levels, it may be beneficial to consult a reproductive endocrinologist who can provide specialized care for fertility issues related to hormonal imbalances.

In conclusion, if you feel that your current healthcare provider is not adequately addressing your concerns about high prolactin levels and the associated symptoms, seeking a second opinion is a valid option. It is essential to have a healthcare team that listens to your concerns and provides a treatment plan that aligns with your goals, especially regarding fertility. Don't hesitate to advocate for your health and seek the care you feel is necessary.

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