Does high prolactin always need an MRI?

[blindbat101]

Just received my blood tests and have some confusing numbers.  I am 47 and having a lot of muscle and bone aches and pains, headaches, and intense breast pain.  I had a partial parathyroidectomy 2 years ago, and have been having problems with ovarian cysts in the past year.  I still have very regular and normal periods, nothing indicating anything unusual.  

They checked my T4, FSH, ferritin, vitamin D, RA, ANA, PTH... all normal.  Prolactin was the only thing that came up abnormal; it was 47 ng/mL (0.0-20.0).  I see my doc in a week to go over the results but have been checking out potential issues with the prolactin.  Just wondering if a high level usually warrants an MRI, if they will order other blood tests, or what the expected course of action might be.  I have a pretty good relationship with my doc, but limited insurance.  Just wondering what a reasonable plan would be and what your recommendations would be based on your experiences?

Thanks!

[rumpled]

Given the intense breast pain, the droopy eye... I would hope your doctor would send you for an MRI. Elevated prolactin can be a number of causes - thyroid among them (your tests were eh not so complete sadly that silly panel is so...ugh)

I would hope though that you at least go see a good eye doctor - they can see if the optic nerve is being effected or other nerves - as the tumor can grow out of the sella. It can be another type of tumor that is hitting on the prolactin area but was not tested for - so you really need a good pituitary exam. I am not sure if you can get into NIH with so little data but they offer low cost care.

[blindbat101]

Additionally -- my FSH was 3.6 (hello -- I'm 47, that's amazing??).  My blood pressure tends to be low (last was 100/50).  I have a droopy eyelid as of about 1 year but vision has not changed.  My main complaint and reason for going to the doc is bone and muscle pain to the point of severe.  Last time it hurt like that was when I was hyperparathyroid.