Endocrine Abstracts

A 47 year old lady referred to the endocrine clinic following raised prolactin levels picked up on investigation for infertility in 2013. She had irregular periods with cycle length up to 50 days. Peak prolactin following diagnosis was 1309mIU/l. She had no headaches, visual problems or galactorrhoea. An MRI head had picked up a 6.3 x 6.9 x 8.3mm right sided pituitary mass in 2013. She was commenced on Bromocriptine. Her periods normalised on treatment to 24 to 25 day cycles. She had a few unsuccessful IVF attempts as at April 2015. At the time of referral to our clinic in April 2018, she was established on Bromocriptine 7.5 mg once day for 5 years, prolactin was 176mIU/L; nadir prolactin level was 65mIU/lin 2017. MRI showed no significant change in the size of the adenoma, no suprasellar mass or optic chiasma compression, with very slight bulging into the adjacent cavernous sinus. By Sep 2018, prolactin rose again to 738mIU/l. She was switched to Carbegoline 500microg a week, which was subsequently increased to twice a week, with the aim of suppressing prolactin to undetectable levels as she was planning conception. She struggled to cope with the increased dose and took it in 3 to 4 divided doses a week. On further review in April 2019, she was planning another IVF cycle, and the plan was to increase to 750micg per week if tolerated. However, by December 2019, Carbegoline was stopped with a plan to repeat the prolactin in 6 months. There was no further IVF planned due to her age and the finding of uterine fibroids. A repeat MRI was to be done in 5 years to monitor any growth of the microadenoma. On further review, in Sep 2021, prolactin had increased to 841mIU/l. Carbegoline was restarted at a dose of 500microg once a week and withdrawn when the prolactin reduced to 76mIU/l. She remained asymptomatic. By November 2022, she had developed irregular periods. A repeat MRI scan showed that there was no change in the size of the adenoma. Repeat prolactin was 177, Oestradiol 513, FSH 20, LH 75. She continues to remain off cabergoline.