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Year 2 - T2 Theme 1 > L15 Lactation and prolactinomas > Flashcards

L15 Lactation and prolactinomas Flashcards

1
Q

Effect of GH on alveolar buds and lobules during puberty

A

Increase in alveolar buds and lobules via IGF-I

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2
Q

Alveolar development during pregnancy

A
  • Increase in ducts and lobules
  • Differentiated secretory units (acini)
  • Colostrum accumulates
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3
Q

What is colostrum

A
  • Is the first form of milk produced by the mammary glands of mammals (including many humans) immediately following delivery of the newborn
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4
Q

Hormonal changes prior to secretory activation in lactogenesis

A
  • Decrease in progesterone/oestrogen
  • Increase in prolactin (cortisol, insulin)
  • Copious milk production after delivery (usually 2-3 days post-partum)
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5
Q

Sugars in breast milk

A
  • Lactose and oligosaccharides
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6
Q

Fats in breast milk

A

○ triglycerides, cholesterol, phospholipids, steroid hormones

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7
Q

Proteins in breast milk

A

○ Caseins, lactalbumin, lactoferrin, secretory IgA, lysozyme

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8
Q

Minerals in breast milk

A

○ Na, K, Cl, Ca, Mg, Phosphate

- Growth factors

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9
Q

Cellular components of breast milk

A

○ Macrophages, lymphocytes, neutrophils, epithelial cells

○ Phospholipids (membrane fragments)

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10
Q

What is prolactin produced by

A
  • Anterior pituitary
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11
Q

What is oxytocin produced by

A
  • Posterior pituitary
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12
Q

Positive feedback loops - lactation

A
  • Regular removal of milk
  • Nipple stimulation
  • Prolactin (anterior pituitary)
  • Oxytocin (posterior pituitary)
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13
Q

Which cells produce prolactin

A
  • Lactotroph cells located in the anterior pituitary
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14
Q

What are prolactin receptors similar to

A
  • Similarities to GH
  • Similar receptor to GH
  • Tyrosine phosphorylation
  • JAK-STAT signalling
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15
Q

Effects of 5HT, TRH and OXT on the pituitary

A

5HT, TRH and OXT released by hypothalamus have excitatory effects on the pituitary which causes released of prolactin

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16
Q

Effect of dopamine on prolactin release

A
  • Prolactin release is inhibited by dopamine
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17
Q

What is lactational amenorrhoea

A
  • Lactational amenorrhea is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding
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18
Q

What does contraceptive efficacy depend on

A
  • Contraceptie efficacy depends on the frequency and duration of breast feeding
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19
Q

Effect of increase in prolactin on other hormone levels

A

Causes:

  • Decrease in GnRH
  • Decrease in LH and FSH, decrease in pulsatility
  • Decrease in oestrogen/testosterone
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20
Q

Where is oxytocin synthesised

A

Synthesised in hypothalamic magnicellular neurons

  • Supraoptic nucleus
  • Paraventricular nucleus
21
Q

What does the posterior pituitary consist of

A
  • The posterior pituitary is neural tissue and consists only of the distal axons of the hypothalamic magnocellular neurons that make up the neurohypophysis
22
Q

Where are neurosecretory granules released into from the posterior pituitary

A
  • Neurosecretory granules released into capillary system of posterior pituitary
23
Q

Where does the afferent signal from receptors in the nipple ascend to when the infant suckles

A
  • Hypothalamus
24
Q

Effects of oxytocin

A

+ uterine myometrial contraction at birth
+ smooth muscle activation in breast ( ‘myoepithelial contraction’)
+ milk let-down
Potential role in maternal behaviour

25
Evolutionary perspective - mammals lactation
- Reproductive strategy involved producing a nutritious secretion from an exocrine gland and encouraging offspring to consume it - Continued nurturing of offspring after birth with benefits including enhanced brain development
26
What does the brain respond to during mating and pregnancy
- Brain responds to hormonal changes associated with ovulation, mating, implantation and pregnancy - Via prolactin and placental lactogens
27
Body mechanisms - coping with fetal growth
- Fluid retention - Cardiovascular and respiratory changes - Altered glucose metabolism - Altered immune system
28
How does the body provide support to the fetus
- Uterine growth | - Development of the placenta
29
Behavioural changes in the mother during pregnancy
- Maternal behaviour - Adult neurogenesis - Reduced anxiety - Increased aggression to protect young
30
How does the body cope with increased metabolic demands during pregnancy
- Increased appetite and fat deposition | - Loss of menstrual cycle
31
Hormonal changes during lactation
- Pattern of firing of oxytocin neurons | - Loss of prolactin negative feedback
32
How does hyperprolactinaemia present in women
- Oligo/amenorrhoea --> increase in risk of osteoporosis - Galactorrhoea - Subfertility - May not have all these symptoms - May present after stopping contraceptive pill (coincidental)
33
How does hyperprolactinaemia present in men
- Erectile dysfunction - Decrease in libido - Visual symptoms - Headaches - Hypopituitarism - Present later - Galactorrhoea/gynaecomastia(rare)
34
Phsyiological causes of hyperprolactinaemia
- Pregnancy | - Lactation
35
How can hypothalamic-pituitary disease cause hyperprolactinaemia
- Micro/macroPRLoma | - Non-functioning adenoma
36
Other causes of hyperprolactinaemia
- Drugs - Stress - Polycystic ovarian syndrome - Hypothyroidism (increase in TRH) - Renal failure, cirrhosis
37
Drugs that increase PRL levels
- Antidepressants and antipsychotics | - Drugs used for nausea and vertigo
38
How do drugs increase PRL levels - mechanisms
- Inhibition of secretion/action of dopamine - DA antagonists - DA receptor blockers - Stimulation of central serotonin (5HT) pathways - 5HT re-uptake inhibitors
39
investigations for hyperprolactinaemia
- Pregnancy test - Renal function (U&E, creatinine) - Liver function tests - Thyroid function - Prolactin (repeat) - LH, FSH - Testosterone (men) - MRI pituitary
40
Micro vs macro adenoma
- Micro < 1 cm diameter | - Macro > 1 cm diameter
41
Tests for a macroadenoma
- Visual fields | - Rest of anterior pituitary function tests
42
Aims of treatment - hyperprolactinaemia
· Restore fertility · Stop galactorrhoea • Also stop nipple stimulation / ‘checking’ (oxytocin) · Restore regular menstrual periods / libido • Oestrogen / testosteone needed for bone protection • Can use exogenous oestrogen / testosterone (contraceptive pill / HRT / testosterone) · Shrink tumour (macroadenoma) • Recovery of anterior pituitary function • Restore vision
43
PRLoma management
``` · ‘MEDICAL’ · Dopaminergic drugs • Cabergoline • (Bromocriptine) · Preserve pituitary function ```
44
Side effects of PRLoma management
• RARE: ○ Fibrotic reactions □ Pulmonary, pericardial, retroperitoneal ○ Psychiatric disturbances
45
Specific features of microPRLoma treatment
- Can take COCP/HRT if fertility not required - Can discontinue treatment in pregnancy - May involute post-partum - Cn trial withdrawal of treatment after - 2 years (may not recur)
46
What is idiopathic hyperPRLaemia assumed to be
- Assumed to be a microPRLoma too small to be detected radiologically
47
Non-functioning pituitary adenoma (NFA) management
• May need surgery & radiotherapy ○ space-occupying effects ○ risk loss of pituitary function • [prolactin] will ¯ with dopaminergic drugs ○ Need to monitor MRI scan & visual fields
48
What can an NFA cause compression of
• Compression of the pituitary stalk ○ ‘Disconnection hyperPRLaemia’ ○ May also occur with hypothalamic masses
49
Risk of transphenoidal hypophysectomy
- Risk to vision with further growth | - Potential risk to pituitary growth - including future fertility prospects (though would be amenable to treatment)

Year 2 - T2 Theme 1 (20 decks)

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