Endocrine Abstracts

A 20-year-old lady presented to her GP with menstrual irregularity and worsening right-sided headaches with associated vomiting. Blood tests showed a mildly raised testosterone level and a markedly raised prolactin level, approximately 80% of which was macroprolactin (normal monomeric prolactin level). She was subsequently referred by her GP for an MRI Pituitary, which was reported as showing a 6-mm hypoenhancing lesion. Medical history includes migraines and hayfever; she was on no regular medications. She reported persistent menstrual disturbance, but no other symptoms, when seen in endocrine OP some 9 months later. There was no clinical evidence of hirsutism. Repeat blood tests confirmed normal monomeric prolactin in the context of macroprolactinaemia; as well as biochemical hyperandrogenism. Review of her MRI scan in our local MDT discounted the possibility of a pituitary lesion. Pelvic sonography confirmed the presence of multiple ovarian cysts. This case illustrates a series of unfortunate mishaps that can lead to over-investigation and misdiagnosis of menstrual disturbance.