Hyperprolactinaemia

Question 1

Define hyperprolactinaemia

Answer 1

Characterised by excess prolactin release by the lactotroph cells in the anterior pituitary

Question 2

Where is prolactin produced

Answer 2

Prolactin is a hormone produced by the lactotroph cells of the anterior pituitary gland

Question 3

What cells in the anterior pituitary produce prolactin

Answer 3

Lactotroph cells

Question 4

What are the 7 hormones produced by the anterior pituitary

Answer 4

Growth Hormone (GH)

Thyroid Stimulating Hormone (TSH)

Follicle Stimulating Hormone (FSH)

Luteinising Hormone (LH)

Adrenocorticotrophic Hormone (ACTH)

Prolactin (PRL)

Melanocyte stimulating hormone (MSH)

Question 5

What two hormones are produced by the posterior pituitary

Answer 5

Antidiuretic Hormone (ADH)

Oxytocin

Question 6

What is the effect of oxytocin

Answer 6

Triggers uterine contractions during childbirth

Question 7

What are the three main functions of prolactin

Answer 7

Induces milk production

Maintains milk production

Proliferation of breast epithelial cells

Question 8

Prolactin suppresses what hormone

Answer 8

Gonadotrophin-releasing hormone (GnRH)

Resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males.

Question 9

How does excess production of prolactin lead to infertility and gonadal dysfunction?

Answer 9

Prolactin suppresses gonadotrophin-releasing hormone (GnRH), resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males.

Thus, excess production of prolactin can lead to infertility and gonadal dysfunction.

Question 10

What is the stimulatory hormone produced by the hypothalamus to stimulate the production of prolactin

Answer 10

There is none

Question 11

Name the two most common causes of hyperprolactinaemia

Answer 11

Physiological e.g. pregnancy

Pathological e.g. prolactinoma (prolactin-secreting pituitary tumour)

Question 12

In women, what are the two key clinical features of hyperprolactinaemia

Answer 12

Amenorrhoea (absent menstruation)

Galactorrhoea (milky secretions from nipples)

Question 13

What is Galactorrhoea

Answer 13

Milky secretions from nipples

Question 14

In men, what are the three key clinical features of hyperprolactinaemia

Answer 14

Sexual dysfunction

Hypogonadism e.g. erectile dysfunction, reduced libido, loss of body hair

Gynaecomastia (enlargement of male breasts)

Question 15

What is the first line therapy for prolactinoma

Answer 15

Dopamine agonists

Question 16

What treatment may be considered for those who do not tolerate dopamine agonists or whose symptoms are not responding to medication

Answer 16

Trans-sphenoidal surgery (removal of the pituitary tumour)