Galactorrhea Flashcards
To determine if breast discharge is truly galactorrhea?
Microscopic smear shows fat droplets
Symptoms of a pituitary secreting adenoma?
- Galactorrhea
- Headache
- Bitemporal hemianopsia
Why does hypothyroidism cause hyperprolactinemia?
Increased TRH triggers increase in prolactin secretion
Effect of prolactin on other hormones? Results in?
Inhibits GnRH pulsations from hypothalamus
Amenorrhea
Mildly elevated hyperprolactinemia in the range of? Follow up test?
If markedly high prolactin level – test?
20-60; TRH test
MRI
Causes of hyperprolactinemia?
- Hypothalamic
- Pituitary adenoma or empty sella syndrome
- Acromegaly
- Hypothyroidism
- Chest surgery/trauma (breast implants, herpes zoster)
- Renal disease
- Drugs
Hypothalamic causes of hyperprolactinemia?
Craniopharyngioma, sarcoidosis, histiocytosis, leukemia
Drug causes of hyperprolactinemia?
- Tranquilizers
- TCA
- Antihypertensives
- Narcotics
- OCP
Patients with secondary amenorrhea have a significantly greater chance of having a pituitary adenoma if?
Low serum estrogen (<40)
When to expectantly manage an adenoma?
- Microadenoma
- No estrogen deficiency
- Patient does not wish to conceive
Hormone deficiency that can lead to hyperprolactinemia?
Primary hypothyroidism
Thyroxine
Patient with hyperprolactinemia and low estrogen that wish to conceive – drug? Why not give to all? Drug if that fails?
Bromocriptine (DA agonist); side effects (orthostatic hypotension, nausea vomiting)
Cabergolamine
Treatment for patient with hyperprolactinemia with adequate estrogen (greater than 40) who do not desire pregnancy?
Periodic progestin withdrawal
Description of surgery for pituitary adenoma?
Cure rate associated with?
Transsphenoidal microsurgery
Pretreatment prolactin levels (level of 100 has a good prognosis; level of 200 has poor prognosis)
Patient with suspected prolactinoma while pregnant – treatment?
Bromocriptine
