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203-T1 > Lacatation and prolactinomas > Flashcards

Lacatation and prolactinomas Flashcards

1
Q

What are the evolutionary benefits of mammals lactating

A
  • Reproductive strategy involves producing a nutritious secretion from an exocrine gland & encouraging offspring to consume it
  • Continued nurturing of offspring after birth with benefits including enhanced brain development
  • Complementary changed in the mothers brain (metabolic, psycho-social/behavioural)
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2
Q

In other mammals how is oxytocin important?

A

Brain responds to hormonal changes associated with ovulation, mating, implantation & pregnancy
via prolactin & placental lactogens

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3
Q

What are the aims of treatment for hyperprolactinaemia?

A
  • 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
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4
Q

What changes occur in breast development in puberty?

A

Oestrogen and progesterone

GH (via IGF-1) increase alverolar buds and lobules

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5
Q

What changes occur in breast development in pregnancy?

A

Oestrogen and progesterone

hCG, Prolactin

Alveolar develpment involved increase in ducts and lobules; differentiated secretory units and colostrum accumulates

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6
Q

Consider lactogenesis

When and how is secretion initiated?

When and how is secretion activated?

A

Progesterone causes intiation during pregnancy. Colostrum formation

Decrease in progesterone and oestrogen. Increase in prolactin (cortisol, insulin)
Milk production 2-3 days post partum.

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7
Q

State the components of breast milk and give an example

A

Sugar (oligosaccharides, lactose)

Fat (TG, cholesterol, phospholipid, steroid hormone)

Protein (Caseins, lactalbumin,secretory IgA, lysozyme)

Minerals (Na, K, Ca, Mg, Cl, Phosphate)

Growth factors

Cellular components (especially in colostrum)
- Macrophages, lymphocytes, neutrophils, epithelial cells, membrane fragments
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8
Q

Galactopoiesis relies on…

It results in…

A

Positive feedback loops
Nipple stimulation
Prolactin (from adenohypophysis)
Oxytocin (from neurohypophysis)

regular removal of milk

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9
Q

Where is prolactin produced?
Which factors inhibit and stimulate its release?

What hormone is it similar to?

What receptor is it similar to?

A

Lactotrophe cells in adenohypophysis.
Serotonin, TRH and oxytocin cause release.
Dopamine inhibits release

Similar to GH

Receptor similar to GH (Tyrosine phosphorylation, JAK-STAT signalling)

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10
Q

What is lactational amenorrhoea and how does it come about?

A

A state of reduced fertility such that it actually acts as an efficient contraception.It depends on frequency and duration of breast feeding

Increased prolactin leads to
- Reduces GnRH –> Reduced LH and FSH, pulsatility –> oestrogen/progesterone

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11
Q

Describe oxytocin

Include:

  • Synthesis
  • Secretion
  • Function
A

It is a nonpeptide synthesised in the supraoptic and paraventricular nucleus of the hypothalamus.

It is secreted from the neurohypophysis in response to nipple stimulation (e.g. infant suckling)

Stimulates

  • uterine myometrial contraction at birth
  • smooth muscle activation in breast (myoepithelial contraction)
  • milk let-down

May play a role in maternal behaviour

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12
Q

How do mammals know when theyre pregnant?

A

Humans - pregnancy tests

Other mammals - brain responds to hormonal changes associated with ovulation, mating, implantation and pregnancy via prolactin and placental lactogens

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13
Q

How does the maternal brain adapt to pregnancy?

And the rest of the body?

A
  • Adult neurogenesis
  • Reduced anxiety
  • Suppressed stress responses
  • Increased appetite and fat deposition
  • Breast development
  • Altered glucose metabolism
  • Placenta development
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14
Q

How does hyperprolactinaemia present in women?

A
  • Oligo/amenorrhoea (increased risk of osteoporosis)
  • Galactorrhoea
  • Subfertility
  • Asymptomatic
  • Contraceptive pill may hide symptoms
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15
Q

How does hyperprolactinaemia present in men?

A
  • Erectile dysfunction
  • Decreased libido
  • Visual symptoms
  • Headaches
  • Hypopituitarism
  • Galactorrhoea/gynaecomastia (RARE)

LATE PRESENTATION

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16
Q

What are the causes of hyperprolactinaemia?

A
  • Physiological (pregnancy, lactation)
  • Hypothalamic disease (micro/macroPRLoma, non-functional adenoma)
  • Drugs
  • Stress
  • PCOS
  • Hypothyroidism (High TRH)
  • Renal failure, cirrhosis
17
Q

Whta drugs increase [Prolactin]?

MOA?

A
  • Antidepressants and antipsychotics
  • Drugs used for nausea and vertigo (Phenothiazines, metoclopramide, domperidone)

MOA

  • Inhibiton of secretion/action of dopamine
  • Stimulaiton of central serotonin pathways (SSRIs)
18
Q

What investigations would you in suspected hyperprolactinaemia?

How would you differentiate betweena micro and macro PRLoma?

Diagnosis of a macroadenoma?

A
  • Pregnancy test
  • Renal function (U&E
  • Liver function tests
  • Thyroid function
  • Repeat prolactin
  • LH/FSH
  • Testosterone (men)

Micro <1cm

  • Visual fields
  • Anterior pituitary function tests
19
Q

How would you ‘medically’ manage a PRLoma?

Side effects:

A
  • Dopaminergic drugs (Cabergoline, Bromocriptine)
  • Preserve pituitary function

(RARE)

  • Fibrotic reactions (pulonary, pericardial, retroperitoneal)
  • Psychiatric distrubances
20
Q

How does managenement of a microPRLoma differe from idiopathic hyperPRLaemia?

A

Micro-

  • Can take COCP/HRT if fertility is not required
  • Discontinue treatment in pregnancy

Idiopathic hyperPRLaemia is assumed to be a microPRLoma too small for radiological detection.

21
Q

How would you manage a non-functioning pituitary adenoma?

A
  • Compression of pituitary stalk
  • Surgery and radiotherapy (to relieve space-occupying effects, risk of pituitary function) e.g. transphenoidal hypophysectomy
  • [Prolactin] will decrease with dopaminergic drugs (monitor using MRI and visual field tests)
22
Q

What can you advise patients presenting with galactorrhoea?

A

Avoid nipple stimulation

203-T1 (15 decks)

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