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Can A Pineal Cyst Cause Hyperprolactinemia?

Posted on Thu, 6 Feb 2014

Question: Can a pineal cyst cause hyperprolactinemia ?

Answered by Dr. Shehzad Topiwala (10 hours later)

Brief Answer: No Detailed Answer: Hyperprolactinemia is a consequence of disturbances in the 'hypothalamo-pituitary' axis ie it is related to the hypothalamus and pituitary regions which are not in proximity of the pineal gland. There are physiological reasons (ie stress, pregnancy for example) that can elevate prolactin levels in the blood, as well as pathological ones (ie abnormal rises as seen in pituitary area tumors). Some medications can raise prolactin levels too Pineal gland cysts have not been described to result in hyperprolactinemia

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (5 minutes later)

I have had hyperprolactinemia for 5 years. Multiple MRI scans have all been negative. My prolactin is always between 100-125. This past year i stopped menstruating. I dont take any medications. I have seen many doctors and none of them can figure out whats causing it. I have tried both bromocriptine and cabergoline and was unable to tolerate them. Do you know of any other causes for my elevated prolactin since i have no microadenoma ? Do you know of any other treatments besides the dopamine agonists since i cant tolerate them ? Help!

Answered by Dr. Shehzad Topiwala (29 minutes later)

Brief Answer: macroprolactin Detailed Answer: Do a lab test for 'Macroprolactin' levels in your blood. This is a less common variant of prolactin in the blood that is innocuous and does not cause any harm and hence no treatment is necessary. However because it is inert, it should not produce any problems either in the from of lack of menses. So see if you have other symptoms of 'hyperprolactinemia' like galactorrhea for example ie milk like discharge from your breasts. If this is present then macroprolactinemia is unlikely. Further, simultaneously get labs for Qualitative hCG (pregnancy test) Serum creatinine TSH Free T4 There are couple other medications that can lower it but they were similar to dopamine agonists. First it is important to diagnose the cause.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (12 hours later)

I was tested for macroprolactin and its not the cause. I have abscense of menstruation as well as galactorrhea. Its been 5 years and MRI pituitary studies with contrast have alwahs been negative. My thyroid hormone levels are all normal. All of my hormone panels come back normal except prolactin is 100-125 and estrogen/progesterone are low. I cant seem to find a doctor who can figure out what is causing this problem in the abscense of pituitary adenoma. Are there rare causes ? Autoimmune diseases ? I am at a dead end trying to find diagnosis and i have seen so many doctors. Any insight into this would be much appreciated .

Answered by Dr. Shehzad Topiwala (44 minutes later)

Brief Answer: Follow up Detailed Answer: It would be worth checking the following labs too: Electrolytes IGF1 8 am cortisol FSH LH Estradiol Alpha subunit Please do not lose hope. See an endocrinologist at an academic center. They will be able to get to the bottom of this

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 minutes later)

Recent labs show FSH 4.7 LH 7.4 Prolactin 108 8 am cortisol 11.7 Estradiol 20.9 Progesterone 0.17 Electrolyte panel normal although i can mention that my labs often show slightly low potassium usually 3.3. Does this help you make any guesses ?

Answered by Dr. Shehzad Topiwala (8 hours later)

Brief Answer: Alpha subunit Detailed Answer: I have noted the above results. Alpha subunit is a blood test that could be of value. Check with your endocrinologist if the following the two tests would be useful after examining you: 1 ACTH stimulation test 2 Midnight salivary cortisol

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (19 minutes later)

Ok i will mention that to him. I never had any hormonal trouble until i had a baby 9 years ago. After i gave birth i had postpartum thyroiditis and was hyperthyroid for over a year. All thyroid tests have been normal but now my prolactin is elevated. Why would pregnancy trigger these problems ? Is it possible i have an autoimmune disease ? If so which one would cause this ?

Answered by Dr. Shehzad Topiwala (13 hours later)

Brief Answer: Fourth follow up question Detailed Answer: There is a condition called Hypophysitis, meaning inflammation of the pituitary that can cause prolactin to rise. Autoimmunity is one of the cause for this. Endocrinologists are best equipped to handle this condition in person.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar