A Case of Hyperprolactinemia

A 28 year old woman presents for evaluation of hyperprolactinemia. She reports a history of irregular menses, and infertility for 10 months. She reports some breast tenderness and headaches, but denies any galactorrhea. Her last menstrual period was May 30th; she denies the possibility of pregnancy. There is no history of illicit drug use. Her physical examination is normal.

Laboratory testing included a Prolactin of 32 (normal less than 21), TSH 1.5 and normal electrolyte panel.

How would you proceed?

Answer: Hyperprolactinemia can be caused by multiple things, the more common ones I see are medication-related and prolactinomas. However, it's important to go back to basics when working these cases up; people can often be wrong (not that they were being malicious in the first place) so it's a good idea to do a confirmatory pregnancy test. In this case, this woman, despite her reassurance to me, turned out to be pregnant.

If the patient was not pregnant and was on no medication that can be implicated, and if the TSH is normal, the next step would be a pituitary MRI.

Bravo to those who answered.