Hyperprolactinemia: prolactinoma or pregnancy?
S Belo1,2, A Magalhães1,2 & D Carvalho1,2
Introduction: High prolactin levels may have several etiologies including the presence of a prolactin producing pituitary adenoma or the treatment with drugs of different classes. Certain physiological states, from which pregnancy stands out, are also characterized by elevated levels of prolactin.
Case: Woman, 28 years old, with no relevant medical history or chronic medication apart from oral contraceptives, begins with amenorrhea in May 2010, without galactorrhoea, headache or changes in visual acuity. She presented no history of menstrual irregularities. Home pregnancy test was performed with a negative result. The patient was evaluated by a Gynecologist in June. An endovaginal ultrasound was performed with no evidence of pregnancy. Therapy with medroxyprogesterone, for 10 days, was attempted without success. Gynecological ultrasound was repeated, again without evidence of pregnancy. The patient was advised to consult an Endocrinologist (first visit in October, on the private sector). Analytical study was conducted with prolactin pool 219.9/182.8/156.8 ng/ml, FSH <0.05 mIU/ml and LH 0.42 mIU/ml. Pituitary MRI was performed later revealing an increased pituitary gland with homogeneous contrast enhancement, suggestive of pituitary hyperplasia. Treatment with bromocriptine was initiated (November) initially 1.25 mg/day with titration up to 5 mg/day. The patient was subsequently oriented to Neurosurgery appointments, from which she was sent to the Endocrinology department of the same institution. At that time, imaging and analytical study was found to be compatible with pregnancy (~33 weeks) confirmed with physical examination (fetal movement) and ultrasound. The analytical findings were normal 5 months after delivery.
Discussion: The onset of amenorrhea in women of childbearing age implies the exclusion of pregnancy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.