Hyperprolactinemia: An Unfamiliar Acquired Cause of Pulmonary Embolism

Abstract

Despite our knowledge of congenital and acquired hypercoagulable states, many unprovoked venous thromboemboli remain idiopathic. High prolactin levels may add diagnostic differential to these unexplained thrombi. We report a case of prolactinemia as a potential cause of a pulmonary embolus (PE) and review the literature to elucidate the connection between high prolactin levels and thrombosis. A 68-year-old female presented with dyspnea and frontal headaches. Exam showed tachycardia, tachypnea, and hypoxemia with an oxygen saturation of 91% on room air. Labs were positive for an elevated troponin. Imaging with a computed tomography (CT) angiogram of the chest and an echocardiogram confirmed a diagnosis of sub-massive PE. A CT of the head showed a mass lesion in the pituitary fossa. A hypercoagulable workup was negative and pituitary hormone levels were within normal limits aside from a high prolactin of 270.9 ng/mL. In our patient, high prolactin secondary to a prolactinoma remained the main culprit in her venous thromboembolism given a thorough negative history and workup for other etiologies. Literature investigating prolactins effect on adenosine diphosphate-mediated platelet aggregation along with clinical scenarios in which elevated prolactin is the only sound explanation for a venous thrombosis may make it a risk factor which should be checked following a patient history indicative of a prolactin derangement.




J Med Cases. 2016;7(11):491-492
doi: https://doi.org/10.14740/jmc2651w