What is the purpose of a brain/pituitary MRI if prolactin levels are normal? If prolactin is normal, wouldn’t that indicate the pituitary is working fine? If prolactin is normal, pituitary seems to be doing it’s job, does that indicate primary rather than secondary? What other lab results would prompt an MRI? I doubt there’s a downside to getting an MRI, just not sure why it would show anything different from lab results or help in making a proper diagnosis in most standard cases.
The consequences of an untreated prolactin secreting pituitary adinoma can be severe, damage to optic nerves. MRI’s are costly, so one does not do this without reason. Secondary hypogonadism can also be from other adinomas and also from physical damage from blows to the head that can sometimes be seen with an MRI.
Prolactin secreting adinomas seem to show up with younger guys.
A prolactin secreting adinoma is typically so well managed with Dostinex/cabergoline, one also does not want to miss that opportunity.
With normal prolactin, MRI’s are not justified and even with high prolactin, many docs want it to be higher. I am convinced that some elevated prolactin levels may be harmful and advocate a trial of Dostinex to see where prolactin and LH/FSH go. This is quite inexpensive and diagnostic. If one did feel better …