Stress-Induced Hyperprolactinemia Mimicking Pituitary Pathology: A Diagnostic Challenge

Hyperprolactinemia is often linked to pituitary adenomas, medications, or systemic disorders, but it can also be triggered by stress. The relationship between stress and elevated prolactin levels is complex and requires thorough evaluation to rule out underlying pathological causes. We present the case of a 37-year-old non-pregnant female with a known history of ovarian endometriosis, diagnosed more than a decade ago and currently managed with dienogest 2 mg daily. During a routine gynecological follow-up, laboratory investigations revealed mildly elevated serum prolactin levels. The patient concurrently reported the recent onset of acne, intermittent blurry vision, and occipital headaches, symptoms that were not present in previous assessments. Due to these atypical features, a multidisciplinary evaluation was initiated to explore possible underlying causes, including pituitary enlargement. Pelvic ultrasonography confirmed stable findings with no new endometriotic lesions. MRI of the brain showed no evidence of pituitary adenoma or structural abnormalities. Comprehensive ophthalmological examination demonstrated normal macular health in both eyes; however, visual field testing (perimetry) detected a central scotoma in the right eye. With no identifiable secondary causes and a recent history of psychological stress, a diagnosis of stress-induced hyperprolactinemia was considered. This case underscores the diagnostic complexity of endocrine abnormalities when neuro-ophthalmologic symptoms are present without radiologic findings. It highlights the importance of considering psychological stress as a potential contributor and reinforces the need for a holistic, multidisciplinary approach to avoid overdiagnosis and ensure appropriate management.