Prolactin disorders

My questions for which I have no answers!!! How little we know our foe?? Ordering TSH & PRL estimations are a very common investigation in day to day clinical practice. Still there are many deficiencies in our knowledge about evaluation of Thyroid function and estimation of prolactin disorders and correlating with symptomatology of the concerned male (erectile disorders & or OAT) and Female pts. For instance how many of us insist on CIA method ( Chemilumincescence method) for evaluating TSH? Most of forget when to assess antimicrosomal ab, Antithyroxine ab, TSA( Thyroid stimulating .immunoglobulins) in clinically suspected thyroid disorders. ? . However, I have some query pertaining to pharmacological hyperprolactinaemia (in this case due to antipsychotic drug/ drugs) therapy which has presumably resulted in sec ameno with a threat of osteoporosis and or surprise pregancy due to escape ovulation while reamaing in sec ameno . . Members may seek help from endocrinologist & psychiatrist friends and enlighten members including this old man. . Query .1:-At what serum PRL level we are almost certain that prolactin is the sole responsible for sec ammenorrhea , as psychological disturbances she is having may itself may be etiologic factor of sec ameno. Query .2:- At what oestrogen level sec ameno may ensue Query .3:-2 At what PRL level osteoporosis becomes a real risk-may kindly eek opinion of endocrinologist colleague . Query 4 :- Will cabergolin or Sicricptin prescribed concomitantly as proposed by many members while on with primary antipsychotic therapy will decrease the efficicafy of antipsychotic drugs?? The same Q lurks in mind when there is rise of PRL due to antihypertensives, antiepileptics, PPI for acidity , Query 5:-In this case PRL is 135 mg(are that bioactive monomer molecules or total PRL ) -How that was measured ( Lab estimated method) To put in other was how perfectly (preferred) methodology of estimation of PRL. The worldwide accepted method is Gel filtration Chromatograoghy, Another theoretical QA that is in my mind for last 40 yrs which I could not ask to any endocrinologist due to my shyness, That Q is we know that PRL is released from Basophilic cells of adenohyphysis (Lactotroph cells), and it is released \as per circadian rhythm and there are tides 14 such spikes like FSH FSH,LH spikes, Then, my theoretical apprehension are we drawing blood at the tide or ebb of PRL .? How to know that, I have no answer for that, Do U have any idea. Query 6 : Is this woman having inappropriate lactation or increased hypersensitive TSH? Query :7 MRI of Pit a must in this case 137 ng/ml or we will take it granted that t is drug induced and can’t be at all due to microadenoma which warrants yearly follow up with a Neurosurgeon? Query 8:- How many of U have prescribed SR formation of Bromocriptin / Inj V Prepn of Bromocriptin in deep IM, monthly once 50 or 75 mg of Bromocriptine or have followed the golden rule of Echo prior to prescribing Cabergolin in this poor country as this drug cabergolin is prohibited in any kind of heart daises.<This rake is also applicable for all parenchymal lung disease and Hypertension as Tibolone is forbidden if BP at menopause is > 160/100 which is not uncommon in our country. .2 Query 8: Does this woman(with PRL 177) mandate a consultation with ophthalmologist as a progression of microadenoma or even a small prolactinoma(> any PRL of 100 ng/ml) may cause pressure on optic nerves and rarely accuse "Bi temporal hemianopia "?