Hyperprolactinemia

Question 1

What are prolactin releasing factors? (7)

Answer 1

TRH
Vasopression
Serotonin
Acetylcholine
Estrogen
Norepinephrine
Opioids (endogenous)

Question 2

Describe the causes of hyperprolactinemia? (9)

Answer 2

1) Physiologic causes (pregnancy, sleep, eating,coitus)
2) Chest wall stimulation
3) Dopamine receptor antagonist (phenothiazines)
4) Medications that decrease catechlamine
5) Tumors
6) Radiation
7) Infiltrative diseases (sarcoid, TB)
8) Primary hypothyroidism
9) Pituitary adenomas

Question 3

Describe symptoms of cavernous sinus syndrome? (3)

Answer 3

1) Headache
2) visual disturbance
3) Cranial nerve palsies III, IV, VII

Question 4

Describe the symptoms of pituitary apoplexy? (6)

Answer 4

1) Acute visual change
2) Severe headache
3) Neck stiffness
4) Hypotension
5) Loss of consciousness
6) Coma

Question 5

Treatment of pituitary apoplexy?

Answer 5

It can cause acute panhypopit and can lead to coma, CNS hemorrhage and death

Treatment includes:

1) glucocorticoid replacement
2) Surgical decompression

Question 6

Investigations involved in work-up for patient suspicious for hyperprolactinemia (3)
(amenorrhea, infertility, galactorrhea, visual disturbance, headache, delayed puberty)

Answer 6

1) Prolactin levels
2) TSH, fT4, T3
3) MRI head

Question 7

Dopamine agonist: Bromocriptine
0.125 mg PO qhs

What are the side-effects?

Answer 7

1) Headache
2) Postural hypotension
3) Blurry vision
4) Drowsiness
5) GI upset
6) Leg cramps

Question 8

Dopamine agonist (D2): Cabergoline
Dose: 0.25 mp PO twice weekly

What is one side-effect to note?

Answer 8

Hypertrophic valvular heart disease (doses 3 mg)

Question 9

When do you discontinue treatment with dopamine agonist?

Answer 9

Following 2 years of treatment with normal prolactin levels

Question 10

Describe management and follow-up for asymptomatic microprolactinoma?

Answer 10

Can be managed conservatively
MRI and serum prolactin q 1-2 years
Risk to progression to macroadnemona <10%

Question 11

Indications for neurosurgical consult

Answer 11

Indications:

1) visual field defects
2) severe headaches
3) Refractory tumors
4) Acutely worsening symptoms

Question 12

Dopamine agonist treatment in pregnancy has increased risk of: (3)

Answer 12

1) Miscarriage
2) Preterm delivery
3) Congenital malformation

Question 13

Risk of growth in pregnancy with microadenomas and macroadenomas?

Answer 13

microadenomas=2%

macroadenomas=21%