side effects of Cabergoline, hypothyroidism

Dear Doc,


I'm female, 46 years. Sorry for my bad english. I have been diagnosed with Prolactinoma ( 0,5 cm) 4 years ago. My Endo prescribed me Cabergoline 0,5 mg per week. From the very beginning I had strong side effects such as low blood pressure, fatigue, dizziness, depressive mood, abdominal pains and anxiety. Even after few months those side effects didn't get better, so my life was just no life anymore. Prolactin levels were after few weeks of Cabergoline normal, in the lower norm range. But I was forced to reduce the Cabergoline dosage, because I couldn't handle with the side effects. So I'm taking all the time only 0,25 mg Cabergoline in a week. The side effects are less now and my Prolactine level was till now only slightly over the norm range ( mostly between 20 and 25, the norm is 4-23). The MRI every year is without a change, the tumor is not getting bigger or smaller.
I have regular period all the time.
But in July 2011  I was diagnosed with a hypothyreoidism  and my Prolactin level was much higher then usual: 40!  Could it be because of the Hypothyroidism or it was my high prolactine who caused Hypothyroidism? I don't have Hashimoto, ( the Endo said, although my Thyroid has only 6 ml volume). I started with Thyroid hormons, 50  L-Thyroxine ( in Germany)
So my Endo suggested to increase Cabergoline too, on at least 0,5 mg pro week.
I have tried this few weeks ago, but I again feel depressed, have blood pressure problems, I'm sleepy all the time, having heavy nausea, and I have strong anxiety attacks, which are worse of all my symptoms. I'm wondering, if those anxiety symptoms are caused by high prolactine, or are they maybe some kind of worsening after taking thyroid meds? THS is now good, 1.4, but Ft3 and Ft4 are still in the lowest norm range.
I don't know what to do- I just can't live with the side effects of Cabergoline, but otherwise there is no hope that the tumor would shrink some day, right?

thank you!

[Daniel M Prevedello, MD]

Dear Cinderella64

If your TSH was elevated before you started T4 replacement, then you have secondary thyroid disfunction and it has nothing to do with your pituitary prolactinoma. A prolactin of 40 without medication is very good and I wonder if you really had a prolactinoma from the beginning. How high was your prolactin level when you discover it?

[Cinderella64]

Dear Doc,

thank you so much for your answer! My prolactin level was at the beginning about 80. ( norm 4-23). The MRI doc wrote that there is a suspicion  for a micro prolactinoma not bigger then 0,5 cm.
I'm still taking 0,25 Cabergoline every 7-10 days, so the level 40 was under this dosage of Cabergoline.
Today I was at my endo and she said that my symptoms are caused by a beginning of a burn out and they have nothing to do with the meds which I'm taking. She suggested antidepressants and anxiolytics. I don't know if this is a solution... I'm just desperate...

[Daniel M Prevedello, MD]

80 is not a confirmation of prolactinoma.
If you want I can review your films free of charge.

[Cinderella64]

Dear Doc, wow, yes, I will immediately look after my films. But how should I send it to you?

[Cinderella64]

Dear Doc,
here you can review my MRI results:

http://www.saranagati-library.net/BSS/mrt/

and then mrt-cd.zip (archive)

Thank you very much!

[Cinderella64]

Dear Doc,

I hope you will menage to take a look on my MRI pictures, it would be very important for me to hear your opinion.

Thanks!

[Cinderella64]

Dear Doc,

sorry for so many questions, but my endo isn't really a great help. Today I'v got the review of the MR from 2009, which I didn't see till now and the radiologist wrote: "slightly increased inhomogeneity of structure of the pituitary gland, which shows decreased volume. Diagnosis Microadenoma, smaller then 0,5 cm, is still questionable."
So this means that the radiology Doc has doubts too about the diagnosis Prolactinoma? And is this inhomogeneity and decreased volume of my pituitary gland very bad? Does it mean that the pituitary has a disfunction? Should I go to another MR now?
My Endo didn't tell me anything about the radiologists review, she just told me to keep taking Cabergoline, so I feel very concerned now and your advice is my big hope now.

Thank you so much!