Hyperprolactinemia

Question 1

what is

Hyperprolactinemia

Answer 1

the increased production of prolactin by the anterior pituitary,

occurs physiologically during pregnancy, lactation, and periods of stress.

Pathological hyperprolactinemia is most often pituitary adenomas and less commonly due to primary hypothyroidism and/or dopamine antagonists (e.g., metoclopramide, haloperidol).

Sex: ♀ > ♂

Hyperprolactinemia is the most common form of hyperpituitarism.

Question 2

what causes hyperprolactinemia

Answer 2

prolactinomas(prolactin secreting pit adenomas)

damage to pituitary stalk(infundibulum)

severe primary hypothyroidism
(reduced thyroid hormones elevases TSH p.duc by pit gland. TSH increaes prolactin secretion by acting as a prolactin releasing hormone)

dopamine antagonists
-antiemetics (metocloopramide)
-antIpsychoticS (Haloperidol)
TCA’S

physiological causes
stress
pregnancy
nipple stimulation
orgasm
sleep
excercise

Question 3

pathophys of hyperprolactinemia

Answer 3

physio causes/ adenoma/ elevated TSH

elevated prolacin

prolactin elevation causes increaseed central dopamine

dopamine inhibits prolactin levels

GnRH suppression and concomitant LH/FSH suppression

Question 4

sx of hyperprolactinemia

Answer 4

females

• galactorhea
• primary/2ndary amenorrhea
• infertility
• reduced libido
• vaginal atrophy

males

• reduced libido
• erectile dysfunction most prominent sx
• gynecomastia

Question 5

dg of hyprolactinemia

Answer 5

repeated early morning basal prolactin measurement (5-20ng/ml)
VOL OF PROLACTIN CORRELATES W/ SIZE OF ADENOMA

TSH/T3&T4 LEVELS to exclude hypothyroidism

MRI to exclude pituitary adenoma

Question 6

rx

Answer 6

dopamine agonist
BROMOCRIPTINE

rx of underlying cause

• prolactinoma: transphenoidal adenectomy
• discontinuiee metocloporamid/ haloperidol