Hyperprolactinemia & Galactorrhea Flashcards
define hyperprolactinemia
elevated levels of prolactin
define glactorrhea (be specific)
watery or milky d/c from the breasts that is NOT in relation to pregnancy
what is a prolactinoma?
prolactin secreting tumor of the pituitary gland
what are some physiologic stimuli for prolactin release? @ least 3
breast and nipple palpation, exercise, stress, sleep, noonday meal (?!)
what is the most common cause of mildly elevated prolactin levels? think …
STRESS!
what is the most common cause of galactorrhea and hyperprolactinemia?
medication use
what is the most common pituitary adenoma associated with hyperprolactinemia?
prolactinoma
what two tests should be done to initiate the evaluation of hyperprolactinemia?
serum prolactic and thyrotopin-stimulating hormone (TSH)
what is the main function of prolactin?
to stimulate growth of mammary tissue as well as produce and secrete milk into the alveoli (this is how increased prolactin - aka hyperprolactinemia) leads to galactorrhea.
prolactin release is stimulated by what time substances?
TRH (thyrotropin releasing hormone) and serotonin
prolactin release is inhibited by what substance?
dopamine
what is the relationship between hyperprolactinemia and GnRH?
hyperprolactinemia inhibits GnRH which leads to amenorrhea/oligomenorrhea, anovulation, and inappropriate lactation/galactorrhea
t or f: hyperthyroidism is a cause of hyperprolactinemia
FALSE - hyPO is a cause (b/c remember, in this instance you will have increased levels of TRH)
t or f: empty sella syndrome is a cause of hyperprolactinemia
TRUE - intrasellar extension of SA space causes compression of the pit gland and an enlarged sella turcica
t or f: acromegaly is a cause of hyperprolactinemia
TRUE
t or f: chronic renal dz is a cause of hyperprolactinemia
TRUE - decreases metabolic clearance of prolactin
t or f: breast implants is a cause of hyperprolactinemia
TRUE
t or f: 50% of women with hyperprolactinemia will have a prolactinoma
TRUE (esp if prolactin levels are greater than 200 ng/mL)
t or f: most prolactinomas are macroadenomas
FALSE: most are microadenomas (NOTE: a majority of micro adenomas DO NOT enlarge)
t or f: treatments is NOT necessary for hyperprolactinemia with or without microadenoma unless the pt desires to get pregnant
TRUE - also true if the estrogen levels are low (should treat b/c of increased risk of osteoporosis)
the most common symptoms of hyperprolactinemia are what two things?
galactorrhea and amenorrhea
what is the modality of choice for diagnosis of pituitary adenomas?
MRI
what is the DOC for women with a prolactin secreting microadenoma who wan to conceive?
bromocriptine
what is the DOC for reducing prolactin levels and shrinking tumors?
cabergoline (dopamine agonist)
t or f: pregnancy increases the likelihood that prolactin levels will decrease or become normal over time
TRUE
t or f: cabergoline is more effective and better tolerated than bromocriptine
TRUE
what is that protocol for bromocriptine use once the pt becomes pregnant?
d/c as it crosses the placenta although not a proven teratogen
what are some common side effects of bromocriptine? how can they be reduced
n&v (reduce by administering vaginally); orthostatic hypotension
