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PITUITARY ADENOMA/RATHKE'S CYST in MRI. PROLACTIN level.

Resolved Question:

Hello,

I would like you to interpret my medical results. My doctor (endocrinologist/gynaecologist) lives in Poland (I live in Uk at the moment)and it’s very difficult to get to see specialist in the UK

I had MRI scan and revealed possibility of pituitary adenoma that may secrete prolactin or I may have Rathke cyst.

I just want to add that my mum has been diagnosed with hyperthyroidism in late twenties and she has been suspected to have Grave’s Basedova disease.

My doctor told me to do some tests to check if I may have problems with thyroid as well. I also told him that I had alopecia areata when I was a child. He was thinking that I may have Hashimoto disease.
My results
My prolactin after metoclopramide (MTC) stimulation,

Reference intervals

Prolactin(PRL)0 ’ 11.28 ng/mL 4.79 -23.30
Prolactin (PRL) 60’ 366.30 ng/mL <10x PRL 0’


Anti TG 15 IU /mL <60
Anti TPO 25 IU/mL < 50
TSH 3.200 mU/L 0.270 - 4.200
FT3 5.020 pmol/L 3.100 - 6.800
FT4 18.150 pmol/L 12.000 - 22.000

Homocysteine 14.35 umol/l 3.70-13.90
glucose 5.8 3.5-6.0

I have read that even the presence of Anti TPO anti TG in the blood may show the beginning of problems with health/ thyroid.

I am 34, white female.

Category: Endocrinologist

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Category: Diabetologist
 22 Doctors Online

Hello.
Thank you for your query at DoctorSpring.com
I understand your concern.
All your reports including Prolactin and Thyroid reports are normal.
Why was the MRI done?
What is the size of the adenoma/cyst?
How are your menstrual cycles and do you have any milk discharge from your nipples?
These questions will answer whether we need to investigate further
Regards.


Patient replied :

1.When I felt streesed I had headaches.(like a high pressure in my head)
2.MRI of the pituitary gland
The test was performed in the three projections, in sequences FSE, GRE T1 and T2, with the dynamic intravenous administration of the contrast agent. No previous test for comparison.
The pituitary gland was not enlarged, measuring 7 mm CC x 17 mm transverse. The irregular [illegible fragment] signal from the posterior lobe was preserved. The infundibulum was set medially. In the central part of the pituitary gland, the lesion measuring approximately 5/6mm CC x 4mm AP, occupying the entire width of the pituitary gland. The signal of the change was slightly increased in the T1-weighted sequence and moderately increased in T2-weighted sequence. The focus shows clear contrast enhancement and probably corresponds to the Rathke's cleft cyst. After the intravenous administration of the contrast agent, the remaining part of the pituitary gland was homogeneously reinforced. No changes in the area of the sella turcica – in the suprasellar and parasellar tanks. The two cerebral hemispheres, brain stem and cerebellum were normal. The ventricles were normal. The signal of the flow within the large vessels of the brain was preserved.
Conclusion: Within the pituitary gland, a focus, probably a cyst with the dense content - the Rathke's cleft cyst? No images from the previous test for comparison. Further observation is recommended – the follow-up test in a year.
3.My menstrual cycle can be every 25 or 23 days so ,all my hormones are within normal level.I had aneamia diagnosed in 2011. I have checked my ovaries,they ok .I had cervical screening and it's ok as well.I dont have any milk discharge from my nipples. My doctor told me that it must be my thing.
my blood results : platelets : 425 ref range 150-400
eosnophill count 0.02 ref range ref range 0.04-0.40
Lymphocyte count 1.08 ref. range 1.00-4.50Prolactin (PRL) 60’ 366.30 ng/mL <10x PRL 0’ this my prolactin after MTC was given.It's a bit too hight dont you think so?
my PRL 60' = 366.30 ng/mL norm PRL 60'=10 x11.28ng/mL =112.80 ng/mL
My breasts are bigger though,.I am slim but have rather big bust.


Hello.
All your reports are fine and it is just an incidental finding on your pituitary imaging that needs follow up with a repeat scan after 6mths to one year.
Prolactin without any stimulus is normal, and in presence of regular menstrual cycles and no milk discharge, you dont need any further tests. MTC stimulated prolactin is not required for any such evaluation.
Regards.


Patient replied :

Dear Doctor,

Regarding my prolactin level- yes it's within normal level.However doctor ordered the test with stimulus for a reason.Dont you think so?
my PRL 60' with stimulus is 366.30 ng/mL and the norm is PRL 60'=10 x11.28ng/mL =112.80 ng/mL IS it not high?
My Homocysteine is 14.35 umol/ whereas the norm is from 3.70-13.90 dont you think it too high? it may indicate inflammation within the body.

The presence anti tpo and anti tg even the small issue suggests some health concern Anti TG 15 IU /mL <60 Anti TPO 25 IU/mL < 50

Mother has hyperthyrodism and I had aneamia in 2011.My period is every 23/ 25 days ....it may mean that i loose lots of iron because i bleed more often.
Can you kindly have a second look at my results?
Can I request second consulation as well?





Hello.
Thank you for the follow up.
Stimulated prolactin levels do not have any diagnostic value as per text books and my experience.
Slightly increased homocysteine and those antibodies are normal and have no pathological significance. Cycles of duration and periodicity you have is normal.
Hope this is helpful,
Regards.


Patient replied :

One doctor told me to do prolactine test.
Then I told the second doctor about my MRI and this doctor recommended doing MTC with prolactine. Why do you think he told me to do the test if I have already had the prolactine test done?
Plus can you tell me please
Why do people are diagnosed with hyperthyroidism and later with Hashimoto or Grave's disease?
Also
I have heard that sometimes you have to repeat the thyirod tests (like TSH and FT3 and FT4)although the result came back correct from lab.Why is that?


I am not aware of a reason for MTC.
You can ask the doctor who advised.

Hashimotos or Graves disease is cause of thyroid disease. Hyperthyroidism is functional state where thyroid is functioning more. The repeat test is required just as a confirmation basis.
Regards.


Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
Dr. J Muthukrishnan and 4 other Medical Specialists are ready to help you

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