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What Causes Low Blood Pressure, Anxiety, Heart Palpitations And Lightheadedness After Taking Cabergoline?

Posted on Sat, 19 Dec 2015

Question: I was diagnosed with a prolactinoma 8 years ago and after treatment with bromocriptine have had 2 children (youngest is 4). November 2014 my GP sent me back to my endochronologist as I had not been taking bromocriptine or any other meds since prior to falling pregnant. My bone density and B12 came back as low so I was put on a contraceptive pill. This was altered to a lower dose pill after continuing side effects. I came off the pill after continued side effects and was put on Cabergoline (1 dose per week). Side effects worsened including low blood pressure, anxiety, heart palpitations and lightheadedness. I also had a holter monitor test which came back OK. I came off the Cabergoline for a few weeks and was then put on Bromocriptine (once daily) however I was still having lightheadedness and palpitations so was advised to stop treatment again. That was nearly 5 months ago and I am still having episodes of lightheadedness, headaches and heart palpitations (though not as severe) as well as a period (most recent was 1 week ago). I had bloods done and thyroid, kidney & liver all came back normal but iron was low (I am now on iron supplements and the level has stabilised). I have also had 3 ECG since November 2014 - all of which were OK. I saw a second endochronologist last week and he told me to remain off any medication as it seems that my body reacts to whatever it is given. I am now on day 4 of my current cycle and the last 2 days I have had quite a severe headache (cycle is normal & not heavy). This appears to be a constant issue and I am wondering if my body could be extra sensitive to the changes in estrogen as I am running out of options and am tired of dealing with side effects when I just want to feel normal again.

Answered by Dr. Shehzad Topiwala (1 hour later)

Brief Answer:
Prolactin

Detailed Answer:
I am sorry to note your medical challenges.

We need to know what your current prolactin level is, and the current size of the prolactinoma as well.

If the prolactin levels are normal there is no need to treat with any medication unless the size of the prolactinoma in the pituitary is large and causing pressure symptoms due to it.
Typically when the prolactin levels are normal, the prolactinoma has usually shrunken.

If prolactin is normal and the pituitary is normal in structure and function , then you need to explore other causes of your symptoms.
This decision, as to whether or not you have any endocrine or hormone related disturbance, is best made by a qualified endocrinologist. I see you have met a couple. So if they clear you from the endocrine perspective, then you need to see a cardiologist and a neurologist to pursue other potential reasons for the way you feel.

I also suggest you get checked for a fairly uncommon condition called Pheochromocytoma. It results in some symptoms similar to the ones you are experiencing. A blood test called Plasma Free Metanephrines is a good way to start screening for this possibility

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

Follow up: Dr. Shehzad Topiwala (4 minutes later)

Thanks. Last prolactin level came in around 900 (was around 1600 when first diagnosed in 2007). It is 8mm and has been since first MRI in 2007

Answered by Dr. Shehzad Topiwala (19 hours later)

Brief Answer:
Follow up

Detailed Answer:
Notable.

This prolactin level needs to be improved. I see you have had challenges with tolerating cabergoline and bromocryptine but see if you can give it another try under supervision of a qualified endocrinologist.

When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:

CBC
Electrolytes
Calcium
HbA1c
Liver function tests
Kidney function tests
TSH
Free T4
25 hydroxy Vitamin D
8 am cortisol
IGF1

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

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

Thanks. If all the tests came back normal, would it be possible that I am sensitive to estrogen? I never had any issues prior to starting treatment & this past year has been awful. I had another bad day today with depression, lightheadedness & mood swings (day 5 of cycle).

Answered by Dr. Shehzad Topiwala (13 hours later)

Brief Answer:
Second follow up

Detailed Answer:
This is unlikely.

What is more important is to rule out a condition related to your pituitary circumstance called Adrenal Insufficiency. You do have some symptoms suggestive of that.

The 8 am cortisol test is useful in this matter

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