Hyperprolactinaemia

Question 1

Where is prolactin secreted from? What does it stimulate?

Answer 1

Anterior pituitary

Lactation

Question 2

What does prolactin raised level cause?

Answer 2

Hypogonadism, infertility and osteoporosis by inhibiting secretion of gonadotrophin releasing hormone (hence reduced LH/FASH and reduced testosterone and oestrogen)

Question 3

What are causes of raised prolactin?

Answer 3

Excess production from pituitary - prolactinoma
Disinhibition, by compression of the pituitary stalk, reducing local dopamine levels (dopamine from hypothalamus inhibits prolactin release)
Use of a dopamine antagonist

Question 4

What are physiological causes of hyperprolacinaemia?

Answer 4

Pregnancy, breastfeeding, stress

Question 5

What are drugs that cause hyperprolactinaemia?

Answer 5

Metoclopramide, haloperidol, methyldopa, oestrogen, MDMA, antipsychotics

Question 6

What are diseases that cause hyperprolactinaemia?

Answer 6

Prolactinoma

Stalk damage pituitary

Question 7

What are symptoms of hyperprolacitnaemia?

Answer 7

Female: Amenorrhoea/oligomenorrhea, infertility, galatorrehoa, reduced libido, weight gain, dry vagina.

Male: Erectile dysfunction, less facial hair, galactorrhea

Late: osteoporosis

Question 8

What test for hyperprolacinaemita?

Answer 8

Basal PRL
Pregnancy test
TFT
U&E
MRI pituitary if other causes ruled out

Question 9

What is management for hyperprolactinaemia?

Answer 9

Dopamine agonists are 1st line

Bromocriptine, cabergoline

Question 10

Why can there be visual disturbances with prolactinoma?

Answer 10

Compression of optic chasm - reduced acuity, diplopia, ophthalmoplegia, visual feield loss