Hyperprolactinemia Flashcards
what is a physiological cause of hyperprolactinemia?
pregnancy
what can cause a lactating woman to have increased prolactin? (2)
what causes it?
nipple stimulation
breast exams
dopamine suppression
what pathological condition can lead to increased prolactin? (2)
prolactinomas
dopamine suppression
what pathological conditions can cause increased prolactin due to a decrease in excretion of prolactin? (2)
hepatic or renal dysfunction
what is the most common cause of pharmacologic hyperprolactinemia?
classic/typical antipsychotics (dopamine receptor antagonists)
what are some symptoms of hyperprolactinemia in men? (5)
decreased libido
erectile dysfunction
infertility
gynecomastia
+/- galactorrhea
what are some symptoms of hyperprolactinemia in women? (3)
amenorrhea/oligomenorrhea
infertility
galactorrhea
what should serum prolactin in men and postmenopausal women be if they have hyperprolactinemia?
over 20
what should serum prolactin in premenopausal women be if they have hyperprolactinemia?
over 30
what should be done with slightly elevated labs in a patient with suspected hyperprolactinemia?
repeat labs fasting
in a patient with hyperprolactinemia, what should be ordered to test for pregnancy?
serum hCG
in a patient with hyperprolactinemia, what should be ordered to test for hypothyroidism?
free T4
TSH
in a patient with hyperprolactinemia, what should be ordered to test for renal disease?
BUN/creatinine
what imaging can be done for a patient with hyperprolactinemia?
pituitary MRI
in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is a somatotroph adenoma?
IGF-1
in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is a corticotroph adenoma?
plasma ACTH
in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is hyperparathyroidism?
serum calcium
in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is male/female hypogonadism?
testosterone (M)
estrogen (F)
FSH
LH
What are 3 reasons we would treat hyperprolactinemia?
chiasmal symptoms d/t mass effect
hypogonadism d/t gonadotropin secretion suppression
bothersome galactorrhea
what medication should be started in a patient with hyperprolactinemia if hypothyroidism is diagnosed?
levothyroxine
what is the first line medication for prolactinoma? (2)
dopamine agonist:
cabergoline
bromocriptine
what is important for a patient to know when being treated for a prolactinoma?
symptoms will return if medication is stopped
what is the 2nd line treatment for a prolactinoma in a women wishing pregnancy or a patient that does not tolerate the medication?
transphenoidal pituitary surgery
what is the 3rd line treatment for a prolactinoma?
radiation therapy
