Prolactin Levels: When to See a Specialist for Treatment

Q: Prolactin Levels: When to See a Specialist for Treatment

Hello： In response to your question, it seems you have been troubled by irregular menstrual cycles and weight issues for some time. <br>Many hormonal interactions can affect menstrual performance, such as elevated prolactin levels, polycystic ovary syndrome (PCOS), and luteal pha

Prolactin

Hello doctor, I have been experiencing irregular menstruation for about eight years, starting when I was in high school.
I thought it was due to academic stress, as I suddenly gained 10 kilograms in the middle of one month (which I have not been able to lose despite eating very little).
After taking some menstrual induction medication for a while, I felt that it was not good to rely on it, so I stopped.
Four years ago, I visited a gynecologist because I suddenly developed excessive hair growth on my hands, feet, and face, including my chin, although it was not very noticeable.
The doctor suspected polycystic ovary syndrome (PCOS) but did not perform any imaging tests.
Due to certain reasons, I did not return for follow-up until recently when I went to a large hospital and was found to have elevated prolactin levels, with a value of 75.
An ultrasound was performed, and the doctor confirmed PCOS.
The doctor prescribed bromocriptine 2.5 mg to be taken daily for six months to see significant effects.
Initially, I had no issues for the first month, but after that, I started experiencing dizziness, nausea, and other symptoms that worsened, so I stopped taking it.
The doctor advised me to see an ophthalmologist due to concerns that an enlarged pituitary gland might be pressing on my optic nerve.
I then saw an ophthalmologist, who referred me to a neurosurgeon for an MRI to check if the pituitary gland was enlarged.
I often experience headaches.
However, the neurosurgeon said that a prolactin level of 75 is only slightly elevated and not concerning, noting that some people with levels over 100 or 200 can still have no issues with lactation.
He suggested waiting until a tumor develops before considering surgery.

I have a few questions:
1.
Which specialist should I see, the neurosurgeon or the gynecologist?
2.
Is it necessary to wait until there is lactation or a tumor before treating elevated prolactin levels?
3.
I often feel breast swelling but have no lactation; could this be caused by elevated prolactin?
4.
If I want to normalize my prolactin levels, are there any faster and less side-effect-prone treatment options available given my current situation (such as nausea and dizziness)?
P.S.
I am unsure if seeing a neurosurgeon for elevated prolactin is appropriate.
I apologize if I am asking the wrong specialty.
Thank you, doctor.

Yu, 20~29 year old female. Ask Date: 2003/10/17

Dr. Hong Xuyi reply Neurosurgery

Hello: In response to your question, it seems you have been troubled by irregular menstrual cycles and weight issues for some time.
Many hormonal interactions can affect menstrual performance, such as elevated prolactin levels, polycystic ovary syndrome (PCOS), and luteal phase deficiency, among others.
Prolactin is secreted by the anterior pituitary gland, and when the pituitary gland is overactive or has a tumor (which can increase prolactin secretion), it can lead to hyperprolactinemia.
Generally, if the prolactin level is greater than 150, an MRI scan may be considered to determine if there is a pituitary adenoma.
In your case, with a prolactin level of 75, doctors typically prescribe bromocriptine for oral treatment.
However, bromocriptine can have side effects such as gastrointestinal discomfort, nausea, vomiting, and headaches.
Since you have been taking it for a month, you can have your prolactin levels rechecked through a blood test to see if the levels have decreased.
If the prolactin levels do not decrease and continue to rise, an MRI scan should be considered.
I hope you can successfully resolve your concerns.
Best wishes.

Reply Date: 2003/10/17

More Info

Understanding elevated prolactin levels and their implications can be quite complex, especially when considering the symptoms and potential underlying conditions such as polycystic ovary syndrome (PCOS). Based on your description, it seems you have been experiencing irregular menstrual cycles, weight gain, and hirsutism (excessive hair growth), which are common symptoms associated with PCOS. The elevated prolactin level of 75 ng/mL, while above the normal range, is not excessively high, but it does warrant further investigation and management.

1. Which Specialist to See?
Given your symptoms and the elevated prolactin levels, it would be advisable to continue seeing an endocrinologist or a reproductive endocrinologist. These specialists are well-versed in hormonal imbalances and can provide a comprehensive evaluation of your condition. While neurologists can assess potential pituitary tumors, your primary concern seems to be hormonal regulation rather than neurological issues. If a pituitary tumor is suspected, an endocrinologist can coordinate with a neurosurgeon if necessary.

2. When to Treat Elevated Prolactin?
Treatment for elevated prolactin levels is typically indicated when there are significant symptoms, such as galactorrhea (milk production), menstrual irregularities, or if a pituitary adenoma (tumor) is detected. In your case, since you have not experienced galactorrhea and your prolactin level is only mildly elevated, immediate treatment may not be necessary. However, if you continue to experience symptoms such as headaches or visual disturbances, further evaluation is warranted. The decision to treat should be based on a combination of your symptoms, prolactin levels, and imaging results.

3. Chest Discomfort and Prolactin Levels:
Breast tenderness or swelling can indeed be associated with elevated prolactin levels. Prolactin plays a role in breast tissue development and can cause changes in breast sensitivity. If you are experiencing persistent discomfort, it would be beneficial to discuss this with your healthcare provider, as they may want to evaluate your hormone levels further or consider other potential causes.

4. Alternative Treatments for Elevated Prolactin:
If you are looking for treatment options with fewer side effects than bromocriptine, which is a common medication used to lower prolactin levels, you might consider discussing cabergoline with your doctor. Cabergoline is another dopamine agonist that is often better tolerated than bromocriptine and has a more favorable side effect profile. It is typically administered less frequently, which can improve adherence to the treatment regimen.

5. Monitoring and Follow-Up:
Regular follow-up with your healthcare provider is essential. Monitoring your prolactin levels, menstrual cycle regularity, and any symptoms you experience will help guide treatment decisions. If you experience significant side effects from any medication, it is crucial to communicate this with your doctor, as they may need to adjust your treatment plan.

In summary, while your prolactin levels are elevated, the approach to treatment should be individualized based on your symptoms and overall health. Consulting with an endocrinologist will provide you with the best guidance on managing your condition, and they can help determine if further testing or treatment is necessary. Remember, it is essential to advocate for your health and seek clarification from your healthcare providers regarding any concerns you may have.

Similar Q&A

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