Hyperprolactinaemia

Question 1

Causes (3)

Answer 1

Excess pituitary production Disinhibition by compression of the pituitary stalk Dopamine antagonists

Question 2

What causes excess pituitary production

Answer 2

Pregnancy, breastfeeding Prolactinoma (PRL >5000) Hypothyroidism (↑TRH)

Question 3

How does the pit stalk get compressed

Answer 3

Pituitary adenoma

Craniopharyngioma

Question 4

Name 2 classes of dopamine antagonists and some examples

Answer 4

Antiemetics: metoclopramide
Antipsychotics: risperidone, haldol

Question 5

Symptoms

Answer 5

Amenorrhoea Infertility Galactorrhoea ↓ libido ED Mass effects from prolactinoma

Question 6

Ix

Answer 6

Basal PRL: >5000 = prolactinoma Pregnancy test, TFTs MRI

Question 7

Rx 1st line

Answer 7

Da agonist: cabergoline, bromocriptine ↓ PRL secretion and ↓ tumour size SE: nausea, postural hypotension, fibrosis (lung and heart)

Question 8

Rx 2nd line

Answer 8

2nd line: Trans-sphenoidal excision If visual or pressure symptoms don’t response to medical Rx