Elevated Prolactin and Tiny ? Tumor


Question

This is a 27 year old female patient G1P1 who has been having persistent galactorrhea since 2005.She has regular monthly cycles. Her prolactin levels are all normal except for one taken in 2005. Lately she also complains of dizziness and tolerable headaches.MRI done showed a 2-3 mm pit mass.The galactorrhea though very scanty is bothering her. How do we proceed? Thanks a lot again for your time and inputs. Lynn f.w.Bilar.MD

Response

Regarding your clinical case, certainly the dizziness and headaches are not related to the 2-3 mm pit mass depicted by MRI: more probably the image refers to a pituitary incidentaloma. As most of serum prolactin measurements were normal, probably the patient has normoprolactinemic galactorrhea, a non rare event in women that already delivered and nursed a baby. I suggest to perform prolactin and progesterone measurements at her supposed luteal phase just to assess ovulation. Anyway, if the galactorrhea bothers her (and secondary causes such as dopamine antagonist drugs or hypothyroidism are discarded), I suggest a course of cabergoline treatment. Sincerely, Marcello D. Bronstein, MD