Hyperprolactinemia & Gynecomastia

Question 1

Hyperprolactinemia Etiology

Answer 1

pituitary adenomas (prolactinomas)
acromegaly.
Hypothyroidism
tons of Physiologic causes
Drugs like verapamil

Question 2

Hyperprolactinemia woman

Answer 2

galactorrhea, amenorrhea, and infertility

Omed: they tend to be found with Microadenomas

Question 3

Hyperprolactinemia men

Answer 3

erectile dysfunction and decreased libido. Gynecomastia is rare

Omed: they tend to be found with Macroadenomas and so bitemporal hemianopsia

Question 4

Hyperprolactinemia dx first

Answer 4

1st Prolactin level
THEN
Thyroid function tests*** can be first hehe
Pregnancy test
BUN/creatinine (kidney disease elevates prolactin)
Liver function tests (cirrhosis elevates prolactin)

Question 5

Hyperprolactinemia when to do MRI

Answer 5

only after
High prolactin level is confirmed;
Secondary causes like medications are excluded; and
Patient is not pregnant.

Question 6

Hyperprolactinemia tx

Answer 6

1 Dopamine agonists: Cabergoline is better tolerated than bromocriptine.
2 Transsphenoidal surgery is appropriate for those not responding to
medications.
3 Radiation is rarely needed.
4 Asymptomatic hyperprolactinemia does not need treatment.

Question 7

Gynecomastia etiologies

Answer 7

Klinefelter syndrome
Hyperprolactinemia
Drugs (spironolactone, opiates, oral ketoconazole, estrogen)
Liver and renal failure (which elevate prolactin levels)
Testicular lesions (Sertoli cells make estrogen)

Question 8

Gynecomastia testing

Answer 8

Test to exclude these disorders=suspected etiology. Do mammography to exclude cancer

Question 9

Gynecomastia Treatment

Answer 9

Tamoxifen
testosterone replacement only if testosterone is
deficient

Question 10

Bromocriptine side effects:

Answer 10

Orthostasis
Lightheadedness
Nausea/vomiting

Refractory and idiopathic cases need surgery.