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Started by cutsman
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First, take a deep breath.

It's hard to give much advice without knowing more details (how high the prolactin is, for one) and other symptoms (headaches, bitemporal visual loss, etc.), and whether you on any medications that can cause an elevated prolactin by affecting dopamine metabolism. The last patient I saw with an elevated prolactin and galactorrhea had it due to medication side effects and I was seeing her for an unrelated finding on her brain MRI (mild Chiari) that her Endo had ordered to rule out prolactinoma. I see plenty of people with prolactinomas (prolactin in the thousands) who are treated with bromocriptine/etc. rather than surgery. Then I also see kids with huge craniopharyngiomas/hypothalamic tumors with normal prolactin levels. :shrug: Getting a MRI is a good step, though.

I hope everything turns out well for you. Feel free to reach out to me by PM.
 
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Hang in there and take it step-by-step. Providers are all terrible patients because we overthink and we hate being out of control of a situation. Do what you gotta do to get healthy, whatever that might be. Your career will be waiting for you after.
 
cutsman said:
I appreciate your response. Deep breaths have been had...and a whole lot of endocrinology reading.

My PRL level was ~275. No meds or history that would otherwise explain the level. I haven’t had any vision changes or headaches. My main symptom has been the hypogonadism.

I messaged my primary doc about the MRI and am anxiously awaiting it to be scheduled. I’m concerned how this might affect my career, but I guess without imaging there’s not a lot to go off of

What a nightmare. It gives me a lot of pause to be on the other side of medical care.
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Not giving anyone specific medical advice on SDN, but in general terms, elevated prolactin as above has a bit of a differential - but a prolactin above 200 is basically only a prolactinoma or mismeasurement. Fractionating the prolactin or checking a "macroprolactin" level would rule out mismeasurement - and then the next step would be an MRI to find a prolactinoma. With mild elevations, sometimes it is difficult to find the tumor, but that level is already getting to the macroadenoma (>1cm) consideration so it would almost certainly show up on MRI.

Regardless though, the vast, vast majority of prolactinomas are treated medically, most commonly with a dopamine agonist. Basically no one outside the VA uses bromocriptine anymore because cabergoline is more effective and is *almost* as cheap (~$35/month for a typical starting dose cash price). Almost all prolactinomas shrink in size with medical therapy and all symptoms (galactorrhea, amenorrhea, hypogonadism) resolve. There's minimal risks to dopamine agonist therapy at the doses commonly used - dizziness/nausea can occur but there's lots of ways to avoid/improve it, and there's no heart valve or psychiatric concerns until you get to quite high doses.
 
cutsman said:
I’m a surgery resident in the USA, a few months in to my dedicated research period. Long story short, after finding out by chance that my testosterone level was low, I’ve just learned that my prolactin is significantly elevated. From what I’ve read this is almost assuredly a prolactinoma. I’m still waiting on an MRI and won’t see an Endo for another month.
I go back to work next July. Any one have experience with this and know how much is this going to mess up my life? Advice would be much appreciated.
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Sorry to hear that. I've come across a blog by an anesthesiologist who was diagnosed and treated for pituitary adenoma. Maybe her experiences will be of help. Please see "About" section of her blog (below).

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