Depression w/ High Prolacting and High ACTH

[grapefruit82]

Hi doctor,  I am a 26 yr old female who has suffered off and on from severe depression/anxiety combined with symptoms of lethargy, trouble gaining weight, feeling out of it constantly as if in a dream, some digestive problems, also tingling in the butt area, and experience of lights being dimmer than normal.  It is possible that I might have had lyme disease in the past, while I was in college, but my depression started before then.  I recently asked my doctor to conduct a variety of tests to see if there was any medical reason for it.  A few things popped up.

Prolactin outside normal range – twice tested and second time was even higher 42 when normal range is 2-29.
ACTH- outside normal range also, too high
Vitamin D- outside normal range, too low (even though I get sunshine)
CT scan of brain shows calcium deposits at basal ganglia - could be abnormal or person to person variation (could it be from lyme disease?) Recommendation was be tested for calcium metabolism disorder.
Other tests lipid panel, TSH, T3, PTH, morning cortisol, electrolytes (including calcium), liver function, kidney function are all normal
Estrogen is somewhat low, and LH/FSH ratio is somewhat high 3:1

I was referred to an endocrinologist, but it might take 3 months!  I would like to know  what further tests I should get to determine what I might have....  so I can ask my GP to do them right away.

I would also like to know if the hormone levels are causing my depression/anxiety, or if the reverse could be true (depression is causing hormone levels to be unbalanced)? Also, could lyme disease have caused hormones to be too high/low?  I would like to see a psychiatrist to get treated, but common sense tells me I should take care of this underlying medical problem before I take any medications to treat depression, and I would like to ask a second opinion if that is in fact a good idea.

Lastly, I would like to get some possible ideas of diagnoses based on lab results/symptoms. Thank you.  

Leah

[bmccrack]

I have the exact same symptoms and i am seeing an an endocrinologist.  I have no tumr or other abnormailities except Hashimotos.  Have you gotten a diagnosis? Seems like my individual issues are being addressed (vit d/prolactin/depression) but i still feel rotten and have a feeling there is a root cause that is missing.

thanks and take care!
bridget

[grapefruit82]

Hi Kevin, along with my other symptoms I experience this symptom of flushed face, and feverishly warm legs often times during late afternoon, early evening.  I can have really cold hands and feet, and still feel my legs burning, and flushed face.  I take my temperature and it is very slightly elevated.  I have asked my GP, and he has no idea, what could possibly be the cause of this? What tests can you suggest?  I would really like any input.  Thank you.

[Kevin Pho, MD]

I agree with the referral to see an endocrinologist.

Normally, an elevated prolactin level necessitates evaluation for a pituitary lesion or tumor.  It is likely that an MRI of the brain would be the recommended step.  This certainly can be discussed with your family physician to have it ready when you see the endocrinologist.

It is possible that the abnormal hormone levels may be associated with depression.  Seeing a psychiatrist is reasonable, but concurrently treating the endocrine issues should be done as well.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd