Hi doctor, I would like help in understanding my situation and a second opinion to that of my GP. I had a blood test two months back which showed serum prolactin levels at 618. I was unaware what the test was for so breastfed before and during the blood being taken. I breastfeed a toddler between 3 to 8 times a day. (He is also eating solids so most feeds are comfort suckling). I had the test repeated last week and the serum prolactin level is 480. I did not breastfeed before or during the test. When the GP discussed my first blood results I disclosed I had been experiencing frequent headaches. I was advised to monitor my peripheral vision. I mentioned my vision has become more blurry than usual, since my eye test four months back. (I have prescription glasses for astigmatism). I have had only 5 menstrual cycles since giving birth 19 months ago. My facial skin is more spotty than it was during puberty and I have become more hairy since pregnancy. Two days before the second blood test I experienced black moving patches of static in my peripheral vision in both eyes. I experienced this a second time the day after the test. I have experienced similar visual disturbances during historic migraines on two occasions, however those were in one eye in the centre of my field of vision. I will disclose this to my GP at my next appointment. I take no medication and my current diagnoses are migraines and depression. The migraines are medicated with over-the-counter painkillers. May I receive an opinion on my current situation. My second blood test has resulted in no further action and I worry I may be overlooked due to breastfeeding.
Hi. To get rid you of your worries, I should let you know the usual level of prolactin in different conditions. The upper limit of normal for many assays of serum prolactin is approximately 500 mIU/L (24 ng/mL). In non-pregnant and non-lactating patients, monomeric prolactin concentrations of 500 to 1000 mIU/L (24 to 47 ng/mL) are likely to be induced by stress or drugs, and a repeat measurement is indicated. Levels between 1000 and 5000 mIU/L (47 to 236 ng/mL) are likely to be due to either drugs, a microprolactinoma (<1cm) or disconnection hyperprolactinemia (pituitary stalk compression blocking dopamine inhibition on prolactin). Levels above 5000 mIU/L (236 ng/mL) are highly suggestive of a macroprolactinoma (> 1 cm) . Your problems may be attributed to migraine, astigmatism you said to have. Persistent and progressive loss of peripheral vision may occur sometimes with headache, morning vomiting, even in that case, which must be further investigated, your levels are not very suggestive of prolactinoma or solely stalk compressing tumour, rather a tuomour in or extending into suprasellar region pressing optic chiasma, may be craniopharyngioma, meningioma, etc. After knowing that you have persistent and progressive loss of peripheral vision your doctor should do fundoscopy usually at bedside, confrontation test, perimetry are also done, and you should be advised MRI of pituitary.