| What is the treatment of prolactinomas? | If medication induced --> stop medication or add dopamine agonist
Dopamine agonist shrinks size and decrease PRL (Cabergoline)
If Very resistant (RARE) then radiation therapy |
| What are the clinical features of hyperprolactinemia? | Women: Galactorrhea, reproductive dysfunction, menstrual disturbance
Men: Hypogonadism symptoms, tumor mass effect, galactorrhea |
| What is galactorrhea? | Nipple secretion, in women if continues after 6 months of delivery considered abnormal and in males it is abnormal
Could be unilateral or bilateral, profuse or sparse, can vary in color and thickness |
| How do we evaluate pt with hyperprolactinemia? | All patients with pituitary mass should test their PRL serum level, and all patients with elevated PRL should look for pituitary tumors.
Minimal PRL elevation may be an indication to large pituitary tumor not secreting PRL |
| What are the causes of hyperprolactinemia? physio and patho | Pregnancy, lactation, stress, sleep, coitus, exercise (physiologic)
Tumors (any kind), granulomas, Infiltrations, rathke's cyst, irradiation, trauma (pathologic) |
| What are the pituitary origins of hyperPRL? | Prolactinoma, acromegaly, macroadenoma compressive, idiopathic, plurihormonal adenoma, lymphocytic hypophysitis, macroPRL |
| What are systemic disorders causing hyperPRL? | Chronic renal failure, PCOS, Cirrhosis, epilepsy, cranial irradiation, pseudocyesis |
| What are the pharmacological causes of hyperPRL? | Dopamine receptor blockers (azines, butyrophenones, metoclopramide)
Dopamine synthesis inhibitors (a methyldopa)
H2 Antihistamines (climetidine and ranitidine)
Estrogens (OCP)
Anticonvulsants (phenytoin)
Opiates
Antidepressants
Antipsychotics/ Neuroleptics |
| What are prolactinomas? | Most frequent secretory pituitary tumor, 40/10,000
female to male micro: 20:1, female to male macro: 1:1
75% of all female adenomas, more than 99% are benign.
diagnosis by immunostaining PRL, tumor size correlates with PRL level |
| What is the difference between macro and microprolactinomas? | Macro (>10mm, men have larger ones, more invasive and rapid growth in men, concentration more than 200ng/ml)
Micro (<10mm, PRL minimal elevation to 100 ng/ml) |
| How is the pathophysio of hyperprolactinoma? | mass pressure on pituitary stalk or portal circulation interrupting inhibitory dopamine |
| What are the signs and symptoms of prolactinomas? | Symptoms of tumor mass (same as ch 3)
Symptoms of hyperPRL (menstrual issues, galactorrhea, sexual dysfunction, osteoporosis (due to sex steroid deficiency)) |
| What is the treatment of prolactinomas? | If medication induced --> stop medication or add dopamine agonist
Dopamine agonist shrinks size and decrease PRL (Cabergoline)
If Very resistant (RARE) then radiation therapy |
