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Year Two - Endocrine System > Hyperprolactinaemia > Flashcards

Hyperprolactinaemia Flashcards

1
Q

What is hyperprolactinaemia?

A

The secretion of excess amounts of the hormone prolactin from the pituitary gland

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2
Q

What is the role of prolactin?

A

To stimulate lactation

It has a negative feedback effect on the gonadotropin releasing hormone (GnRH).

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3
Q

What are the resulting effects of hyperprolactinaemia on sex hormones?

A

Low levels due to an enhanced negative feedback

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4
Q

Where is prolactin produced?

A

Anterior pituitary

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5
Q

What hormone inhibits the release of prolactin?

A

Dopamine produced in the hypothalamus

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6
Q

What are the two pathophysiological causes of hyperprolactinaemia?

A

Excess production of prolactin from the pituitary

Disinhibition of dopamine

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7
Q

What are the three causes of dopamine disinhibition on prolactin?

A

Compression of the pituitary stalk

A reduction in dopamine levels

The use of a dopamine antagonist

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8
Q

What are the three physiological causes of hyperprolactinaemia?

A

Pregnancy

Lactation

Stress

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9
Q

What are the four pharmacological causes of hyperprolactinaemia?

A

Dopamine antagonists

Dopamine depleting drugs

Oestrogens

Antidepressants

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10
Q

What are the two dopamine antagonists which can cause hyperprolactinaemia?

A

Chlorpromazine

Metoclopramide

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11
Q

What are the four pathological causes of hyperprolactinaemia?

A

Hypothyroidism

Pituitary tumours, which secrete prolactin

Chronic renal disease

Polycystic ovary syndrome

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12
Q

What are the six signs and symptoms of hyperprolactinaemia?

A

Galactorrhoea

Amenorrhoea

Infertility

Bitemporal Hemaniopia

Erectile dysfunction

Gynaecomastia

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13
Q

What is galactorrhoea?

A

This is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing

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14
Q

What is amenorrhoea?

A

This is the absence of menstrual periods in a women during their reproductive years

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15
Q

Why is bitemporal hemianopia a symptom of hyperprolactinaemia?

A

Visual changes are experienced if the hyperprolactinaemia is associated with a pituitary gland tumour – as this can compress the optic chiasm

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16
Q

What three investigations are used to diagnose hyperprolactinaemia?

A

Prolactin blood test

Prolactin stimulation test

MRI scan

17
Q

How do we carry out a prolactin blood test?

A

This blood test requires a venepuncture, which is the puncture of a vein to withdraw blood

This test must be carried out between 9am and 4pm

18
Q

What is the normal level of prolactin?

A

Less than 20ng/mL

19
Q

What prolactin level indicates hyperprolactinaemia?

A

25ng/mL (550mu/l)

20
Q

What is a prolactin stimulation test?

A

A prolactin stimulation test involves injecting patients with metoclopramide, which is a drug involved in controlling prolactin levels. Specifically, it is a dopamine antagonist that exerts inhibition on prolactin secretion

21
Q

How does a prolactin stimulation test affect normal patients?

A

It results in increased levels of prolactin and a small increase in TSH levels

22
Q

How does a prolactin stimulation test affect those with microprolactinoma?

A

Metoclopramide will result in a marked increase in TSH levels, however there is no effect on the prolactin levels

23
Q

How does a prolactin stimualtion test affect those with macroprolactinoma?

A

Metoclopramide will result in no effect on either the TSH levels or the prolactin levels

24
Q

How is an MRI scan used to diagnose hyperprolactinaemia?

A

An MRI scan of the pituitary gland is used to exclude any other pituitary gland abnormalities that may be responsible for the symptoms – such as a pituitary tumour

25
Q

How do we treat hyperprolactinaemia pharmacologically?

A

We prescribe patient’s dopamine agonists

26
Q

Name two dopamine agonsists used to treat hyperprolactinaemia

A

Bromocriptine

Cabergoline

27
Q

What are the three side effects of cabergoline? How do we monitor if patients have developed these side effects?

A

Impulse control disorders

Cardiac valve fibrosis

Lung fibrosis

ECHO every 5 years

28
Q

When do we use surgical treatment to treat hyperprolactinamia? What surgery is used?

A

It is only used in cases where pharmacological treatment is contraindicated

It involves removal of the pituitary adenoma via trans-sphenoidal surgery

29
Q

How do we manage patients who wish to concieve whilst being affected by tumour-induced hyperprolactinaemia?

A

We must monitor them closley for symptoms and signs suggestive of tumour enlargement

We usually stop pharmacological treatment to prevent adverse effects on the pregnancy or foetal development

Year Two - Endocrine System (17 decks)

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