Thursday, January 15, 2009

Everyone comes to terms with adversity in their own way. I'm usually a joker, occasionally a moper, always a writer.
About a month ago I began having some bizarre symptoms--the most family-appropriate being killer headaches, but others...well, I'll put these in medicalese and hope those with vested interest either already know what I'm talking about or have the motivation and intellectual capacity to consult a dictionary...amenorrhea (which I've had quite a while...occupational hazard of ED/distance running, and speaking of which, the marathon training has been going phenomenally, thanks for asking!) and galactorrhea. Well. I'm definitely not pregnant--nor have I been, ever, and I'm not on birth cotrol. So, what's high-ish on a differential diagnosis for such a set of symptoms? Anyone? Bueller? Bueller? (See? Joker). That's right, Virginia, this weird little thing called a prolactinoma--a prolactin (the hormone that causes women--and sometimes men--to secrete milk from the mammary glands) secreting tumor on the pituitary.

Usually benign, generally treatable with medication--though the medication has a not-so-cheery side effect profile, including inducing depression, which is at the top of a long list called "Shit I don't need to deal with, especially during my medical education, thank you SO much." And then there's, y'know, brain surgery. But of course I'm putting the cart before the horse. The preliminary tests come back tomorrow. We'll see what they show.

4 comments:

Anonymous said...

I would also check TSH/T4, as prolactin levels can increase in hypothyroidism... Though psychotropic meds (antipsychotics mainly) increase prolactin levels. And once you do get an MRI, learn the threshold at which prolactin microadenomas can be medically managed with bromocriptine... Because that will definitely be tested on your obgyn rotation :)

Tracy Crowe Jones said...

Okay...weird. Just a few hours ago I was reading about this. Apparently, it can be a side effect of risperdol. Are you on that, by any change?

Also, what marathon are you training for? Steve and I are running the StL half on April 19.

Anne said...

Dual answer--I do have Hashimoto's thyroiditis, but I'm on T4 replacement, and my TSH came back normal. I'm not on Risperdal, no, though I know several people who have had this (interesting) side effect. I'm training for the St. Louis marathon, being as I'm here and all. Wanna stay at my apartment? : )

Anonymous said...

Ahh, that changes everything! For unknown reasons (and mixed etiologies at best), there is a higher incidence of hyperprolactinemia in those with Hashimoto's, SLE, RA, etc. Once you have one autoimmune disorder, you're at a higher risk of more... And for whatever reason, the autoantibodies can affect the dopamine pathways and cause other hormone abnormalities like you see. Usually, the art of medicine says we should try to use occam's razor and put multiple things together... Which is slightly better than having to have brain surgery I would think :) anyway, hope you get good news.