Hyperprolactinemia

Question 1

where is PRL secreted

Answer 1

anterior pituitary

Question 2

what hormones secreted by anterior pituitary

Answer 2

FSH, LH, TSH, ACTH, Prolactin, GH

Question 3

physiologic increases in prolactin

Answer 3

pregnancy, breastfeeding, stress, sexual intercourse, medications

Question 4

how does nipple stim cause inc prolactin?

Answer 4

neural pathway! inc related to degree of E2 related lactotroph hyperplasia

Question 5

what medications can cause hyperprolactinemia

Answer 5

antipsychotic, prokinetics (reglan), methyldopa, morphine, H2 Ag, buspir

Question 6

Relationship between dopamine and prolactin?

Answer 6

dopamine is police officer! dec dop, inc pro

Question 7

pathologic increases in prolactin

Answer 7

increased production, neurogenic, reduced elimination,, hypothalamic (hypothyroidism)

Question 8

what is empty sella syndrome

Answer 8

subarachnoid space herniates down into pituitary fossa compressing gland against sella floor

Question 9

How does PRL affect hypogonadism

Answer 9

Dec GNRH, Dec fSH/LH, dec Estradiol. Dec androgen synthesis, decrease aromatase, –> early luteolysis

Question 10

Work up for PRL?

Answer 10

Repeat fasting, beta hcg, check meds, CMP to eval renal/hepatic, TSH, IGF if signs, MRI pituitary

Question 11

treatment goals of PRL?

Answer 11

restore gonadal fxn, restore fertility, prevent osteoporosis, redue tumor size, prevent progression

Question 12

what are treatment options?

Answer 12

expectant, dopamine agonists, surgery, radiation

Question 13

what dop agonists?

Answer 13

bromocriptine, cabergoline