Hyperprolactinemia & Galactorrhea

Question 1

define hyperprolactinemia

Answer 1

elevated levels of prolactin

Question 2

define glactorrhea (be specific)

Answer 2

watery or milky d/c from the breasts that is NOT in relation to pregnancy

Question 3

what is a prolactinoma?

Answer 3

prolactin secreting tumor of the pituitary gland

Question 4

what are some physiologic stimuli for prolactin release? @ least 3

Answer 4

breast and nipple palpation, exercise, stress, sleep, noonday meal (?!)

Question 5

what is the most common cause of mildly elevated prolactin levels? think …

Answer 5

STRESS!

Question 6

what is the most common cause of galactorrhea and hyperprolactinemia?

Answer 6

medication use

Question 7

what is the most common pituitary adenoma associated with hyperprolactinemia?

Answer 7

prolactinoma

Question 8

what two tests should be done to initiate the evaluation of hyperprolactinemia?

Answer 8

serum prolactic and thyrotopin-stimulating hormone (TSH)

Question 9

what is the main function of prolactin?

Answer 9

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.

Question 10

prolactin release is stimulated by what time substances?

Answer 10

TRH (thyrotropin releasing hormone) and serotonin

Question 11

prolactin release is inhibited by what substance?

Answer 11

dopamine

Question 12

what is the relationship between hyperprolactinemia and GnRH?

Answer 12

hyperprolactinemia inhibits GnRH which leads to amenorrhea/oligomenorrhea, anovulation, and inappropriate lactation/galactorrhea

Question 13

t or f: hyperthyroidism is a cause of hyperprolactinemia

Answer 13

FALSE - hyPO is a cause (b/c remember, in this instance you will have increased levels of TRH)

Question 14

t or f: empty sella syndrome is a cause of hyperprolactinemia

Answer 14

TRUE - intrasellar extension of SA space causes compression of the pit gland and an enlarged sella turcica

Question 15

t or f: acromegaly is a cause of hyperprolactinemia

Answer 15

TRUE

Question 16

t or f: chronic renal dz is a cause of hyperprolactinemia

Answer 16

TRUE - decreases metabolic clearance of prolactin

Question 17

t or f: breast implants is a cause of hyperprolactinemia

Answer 17

TRUE

Question 18

t or f: 50% of women with hyperprolactinemia will have a prolactinoma

Answer 18

TRUE (esp if prolactin levels are greater than 200 ng/mL)

Question 19

t or f: most prolactinomas are macroadenomas

Answer 19

FALSE: most are microadenomas (NOTE: a majority of micro adenomas DO NOT enlarge)

Question 20

t or f: treatments is NOT necessary for hyperprolactinemia with or without microadenoma unless the pt desires to get pregnant

Answer 20

TRUE - also true if the estrogen levels are low (should treat b/c of increased risk of osteoporosis)

Question 21

the most common symptoms of hyperprolactinemia are what two things?

Answer 21

galactorrhea and amenorrhea

Question 22

what is the modality of choice for diagnosis of pituitary adenomas?

Answer 22

MRI

Question 23

what is the DOC for women with a prolactin secreting microadenoma who wan to conceive?

Answer 23

bromocriptine

Question 24

what is the DOC for reducing prolactin levels and shrinking tumors?

Answer 24

cabergoline (dopamine agonist)

Question 25

t or f: pregnancy increases the likelihood that prolactin levels will decrease or become normal over time

Answer 25

TRUE

Question 26

t or f: cabergoline is more effective and better tolerated than bromocriptine

Answer 26

TRUE

Question 27

what is that protocol for bromocriptine use once the pt becomes pregnant?

Answer 27

d/c as it crosses the placenta although not a proven teratogen

Question 28

what are some common side effects of bromocriptine? how can they be reduced

Answer 28

n&v (reduce by administering vaginally); orthostatic hypotension