Hyperprolactinaemia

Question 1

Prolactin:

• Where is it released from?
• What neurotransmitter inhibits it?
• What hormone does prolactin inhibit at high levels?

Answer 1

Anterior pituitary

Dopamine from hypothalamus

GnRH

Question 2

Pathophysiology:

What type of functional pituitary adenoma can cause excess production?

What may cause disinhibition i.e what will stop dopamine inhibition?

How can meds also cause it?

Answer 2

Prolactinoma

Stalk compression of the hypothalamus - usually a non-functional tumour blocking hypophyseal-portal tract

Use of a dopamine antagonist:

• Antipsychotics
• Antidepressants
• Opiates

Question 3

Physiological causes:

What physiological causes are there?

Answer 3

Pregnancy and lactation
Hypoglycaemia
Illness - MI, surgery, stress
Daily activities - exercise, eating, sex and sleep

Question 4

Presentation:

What does it typically present with and why?

They get 2 endocrine disorder as a consequence, what are they?

What will high PRL levels begin to produce in the breasts?

Answer 4

Hypogonadotropic hypogonadism (2* hypogonadism)

Due to interruption of pulsatile GnRH by high PRL

Hypogonadism
Hypopituitarism

Breast milk - galactorrhoea

Question 5

Presentation:

Hypogonadism - what are some S+S for females and males

What bone disease occurs in late disease?

Answer 5

Sexual dysfunction - vaginal dryness
Decreased libido
Menstrual irregularities

Erectile dysfunction
Reduced facial hair
Galactorrhoea

Osteoporosis - PTL increases resorption

Question 6

Presentation:

Pituitary adenoma mass effects - what does it cause?

Answer 6

Headache
Tunnel vision
CN palsy
Seizure

Question 7

Investigations:

What needs to be ruled out as it could affect the PRL levels?

Answer 7

Pregnancy and germ cell tumours

Question 8

Management:

What can be prescribed knowing what can inhibit PRL release?

Answer 8

Dopamine agonists