A little off topic, but in regards to fertility, if a woman with PCOS is given all the conventional fertility tests by a doctor and they all come back normal except high prolactin, what would you think is going on? It could be a pituitary tumor, but once that was ruled out, what might you think would be causing it? She was under extreme stress at the time of the test. Could that be it?

Dr. Amy Nett:  Stress could certainly contribute to it, so number one, repeat the prolactin. If she’s no longer under such stress, then if the prolactin is still elevated, you need to do workup for a pituitary tumor. You say “once that’s ruled out,” so I don’t know if it has been or not, but you absolutely need to rule out a pituitary tumor, and I would recommend an MRI with contrast. Unfortunately, you have to do multiphase contrast-enhanced images to look for a microadenoma because microadenomas are really difficult to see. I would probably do imaging on a 3 Tesla magnet with multiphase contrast enhancement. Such a high prolactin, it seems unlikely to be due to stress alone at that level, so again, repeat the prolactin. If it’s still elevated, contrast-enhanced MRI, multiphasic. It needs to be protocoled specifically for pituitary microadenoma.