Abnormal Lab Results

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If someone was to have a Prolactin, Serum of 31.6ng/mL which is high and a TSH of 0.208uIU/mL which is low and they aren't pregnant how would you proceed? What tests do you think the doctor would order? What treatment do you think the doctor would do?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

moved to nursing student assistance for best response

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There is a connection between these two labs.

Look and find what causes elevated prolactin.

There is more than one reason, but the results of these two labs ring a bell.

If you know what can possibly cause it, you have a good idea of tests and treatments.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

grea site....Lab Tests Online: Welcome!

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A great book that will give you this and answers to may other like questions, unless you have given up on paper in favor of hitting "Send": Joyce Lefever Kee, Laboratory and Diagnostic Tests with Nursing Implications. Strongly recommended for NCLEX and school because of that "nursing implications" thing. MIne's on my desk right now. :)

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Specializes in Pedi.
If someone was to have a Prolactin, Serum of 31.6ng/mL which is high and a TSH of 0.208uIU/mL which is low and they aren't pregnant how would you proceed? What tests do you think the doctor would order? What treatment do you think the doctor would do?

What do YOU think? I could tell you what I think and there's a very obvious answer to me as a previous neuro nurse but I'd rather you tell me what you think. What would cause a high prolactin level in a non-lactating woman? You don't say whether or not this patient is a woman but since you say she's not pregnant, I'm assuming it is. It COULD be a man though, that's a hint.

Treatment would depend on the results of the test and the reason for these abnormal lab values. Figure those out first and then the rest will come.

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It's definetly a woman. I would order an MRI with contrast and repeat bloodwork... I guess the MRI would be to see if the person has a pituitary tumor. Does that seem right?

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Specializes in Pedi.
It's definetly a women. I would order an MRI with contrast and repeat bloodwork... I guess the MRI would be to see if the person has a pituitary tumor. Does that seem right?

Yes, pituitary tumors (prolactinomas) can be hormone secreting.

When you answer the question for school be sure to word it appropriately as in "I would expect the doctor to order..." because RNs do not order MRIs. Outside of the neuro world people think a low TSH means primary hyperthyroidism but IN the neuro world, it often indicates CENTRAL hypothyroidism- the pituitary isn't secreting enough TSH to stimulate the thyroid so circulating levels of thyroid hormones are low. My endocrinologist always shakes his head when other doctors of mine order a TSH without a T4 and Free T4 level.

Now, depending on the results of the MRI... what treatment(s) would you expect?

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Yes, pituitary tumors (prolactinomas) can be hormone secreting.

When you answer the question for school be sure to word it appropriately as in "I would expect the doctor to order..." because RNs do not order MRIs. Outside of the neuro world people think a low TSH means primary hyperthyroidism but IN the neuro world, it often indicates CENTRAL hypothyroidism- the pituitary isn't secreting enough TSH to stimulate the thyroid so circulating levels of thyroid hormones are low. My endocrinologist always shakes his head when other doctors of mine order a TSH without a T4 and Free T4 level.

Now, depending on the results of the MRI... what treatment(s) would you expect?

If a prolactinoma is present I would expect the treatment to be oral dopamine agonists. If that didn't work then possibly surgery. For someone who can't have surgery then radiation.

What percent of prolactinomas are canerous?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Google is your friend......

[h=3]What Is a Prolactinoma?[/h] A prolactinoma is a benign tumor of the pituitary gland that produces a hormone called prolactin. It is the most common type of pituitary tumor. Symptoms of prolactinoma are caused by too much prolactin in the blood (hyperprolactinemia) or by pressure of the tumor on surrounding tissues.
Prolactinoma -- Endocrine Resource Center -- Thyroid Disease Site
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Specializes in Pedi.
If a prolactinoma is present I would expect the treatment to be oral dopamine agonists. If that didn't work then possibly surgery. For someone who can't have surgery then radiation.

What percent of prolactinomas are canerous?

Prolactinomas are not malignant. That said, whether or not a BRAIN tumor is pathologically malignant doesn't necessarily matter because of the location within the brain... even low grade or "benign" brain tumors can be deadly. I've known two people with prolactinomas, both of whom had surgery to resect the tumor... one via craniotomy and the other transphenoidally. The neuro-oncologists I know (my own and the ones I've worked with over the years) generally try to avoid radiation in non-malignant brain tumors as radiation can cause secondary malignancies. I've also known several people who died from radiation induced cancers.

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