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What Causes Fainting Episodes When Diagnosed With Hyperprolactinemia?

Posted on Sat, 21 Jan 2017

Question: My wife recently has been having some hormone issues. It started in early December when she began getting breast discomfort and then nipple discharge (both breasts) which lead to a visit to Urgent Care. The discharge tested positive for bacteria, and then she was given a blood test which showed slightly high prolactin levels (38).

She has also had high prolactin in the past as seen in her 2011 blood test and subsequently was given an MRI that showed nothing. Her prolactin was at 33 5 years ago.

Most of this was not of much concern to us until today when she nearly fainted while at work. Though we have no clue if this is related, overall my wife feels something is wrong, so we want to take this seriously.

It should be noted that she is a high stress individual and has had epilepsy in the past. She had frontal lobe surgery in 2010 and has been seizure free since then. Her mother also has a history of fainting, so again this may not be related.
Her only current medication is birth control (which I have read rare cases of this increasing prolactin)
Is it time for another MRI? Should she be seeing an endocrinologist?
Thank you kindly, XXXX

Answered by Dr. Mirjeta Guni (39 minutes later)

Brief Answer:
About high prolactin level;

Detailed Answer:

Hello and welcome on HCM !
I can understand your concern regarding to your wife's health.
The prolactin level you reported, can not be the cause of fainting.

It may be caused by oral contraceptives but you mentioned that it was high even 5 years ago when she was not taking them.

I would recommend to repeat the MRI only if this slightly elevated prolactin associated with galactorrhea would be the cause of irregular menstrual cycle and infertility, otherwise even if a microadenoma is confirmed with MRI it wouldn't cause problems if left untreated.

I would recommend to check prolactin twice after stopping the contraceptive pills ; at 8.00 a.m and 8.30 to exclude an elevation by the stress.

That is what we ( endocrinologists) suggest in these cases.
Hope i have been helpful. Feel free to ask further.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (18 minutes later)

It should have been noted that she was in fact on birth control back in 2011. She started at age 16.

The birth control is called cryselle.

Also her family has a history of thyroid issues though it seems her thyroid was fine in the blood work?

Answered by Dr. Mirjeta Guni (3 minutes later)

Brief Answer:
If TSH is normal, thyroid is excluded.

Detailed Answer:
Welcome back!

Than birth control pills may be a cause of high prolactin as the MRI didn't reveal any lesion (i would stress that it should have been done with i.v. contrast).

As you've mentioned that TSH is normal, thyroid is excluded as a cause of high prolactin.

Let me know if I can assist you further
Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (9 minutes later)

The MRI was done with contrast and was negative, but this was 5 years ago. Is it possible she has developed a lesion since?

Also would you recommend stopping birth control and retesting prolactin before considering another MRI?

Or would you recommend getting on with it and getting a MRI?

Answered by Dr. Mirjeta Guni (6 minutes later)

Brief Answer:
Repeat prolactin after stopping contraceptive pills.

Detailed Answer:
Welcome back,

I would recommend to stop the contraceptive pills and repeat it at 8.00 a.m and 8.30.
If it persists high then repeat the MRI.

Wish her good health.
Best wishes,
Dr.Mirjeta

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee