Lactation Flashcards
Prolactin is inhibited and stimulated by what?
Dopamine inhibits
TRH oxytocin and serotonin stimulate
Lactational amenorrhoea?
Periods don’t continue whilst breast feeding
High prolactin causes?
Dampen gnRH, low LH and FSH and low oestrogen and testosterone, hence lactational amenorrrhoea
Oxytocin is synthesised?
Hypothalamic magnicellular neurons, supraoptic and paraventricular nuclei
Presentation of hyperprolactinanemia?
Oligo/amenorrhoea, galactorrhoea and subfertility, erectile dysfunction decreased libido, visual symptoms, hypopituitarism
Symptoms of prolactinaemia in men cause?
Visual symptoms, headaches, hypopituitarism, erectile dysfunction, decreased libido
Causes of prolactinaemia?
Prolactinoma, non functioning adenoma, stress, drugs, PCOS, hypothyroidism, renal failure
Drugs that increase prolactin?
Antidepressants antipsychotics, drugs used for nausea and vertigo (metocloperamide, domperidone and phenothiazine)
Prolactinoma management?
Dopaminergic: cabergoline and bromocriptine
Side effects: fibrotic reactions pulmonary, pericardial
Psychiatric
Side effects of prolactinoma drugs?
Fibrotic reaction, pulmonary pericardial (heart valves)
Psychiatric disturbances
Milk production secretory initiation and activation hormones?
Progesterone for initiation and decreased progesterone and oestrogen for activation.
Activation- increase in prolactin, cortisol and insulin
How does prolactin have a similar receptor to GH?
Due to tyrosine phosphorylation and JAK-STAT signalling
Causes of hyperprolactinaemia?
Physiological, hpaa disease, drugs, stress, other conditions pcos, hypothyroidism, renal failure cirrhosis
How do antidepressants and antipsychotics increase prolactin?
Inhibit secretion of dopamine, da antagonist and da receptor blocker, stimulation of seretonin
Macro in pituitary is what size?
More than 1 cm
Aims of Treatment for hyperprolactinaemia?
Restore fertility, stop galactorrhoea, restore periods and libido, shrink tumour
Treatment for microprolmas?
Cocp or hormone replacement therapy, may involute postpartum
How does a non functioning adenoma cause hyperprolactinaemia?
Compression of pituitary stalk cause disconnection/ hypothermic masses leading to no inhibition through dopamine
Which hormone causes secretory initiation?
Progesterone
What happens in secretory activation?
Drop in progesterone/ oestrogen
Increase in prolactin, cortisol and insulin
Copious milk production after 2/3 days
Prolactin is similar to?
GH and has similar receptor and signalling such as tyrosine phosphorylation and JAK STAT signalling
Issues with non-functioning adenoma?
Compressing pituitary stalk responsible for passage of dopamine hence medication wont work so hyperprlaemia
What is the visual field called?
Humphreys test
In post. Menopausal women LH and FSH are?
High
how to treat non functioning pituitary adenoma?
Transphenoidal hypophysectomy
What investigations should you do for high prolactin?
Pregnancy test Renal function- u/e creatinine Liver function test Thyroid Prolactin repeat LH/FSH Testosterone MRI pituitary
What are the aims of prolactin treatment?
Restore fertility Stop the stimulation, galactorrhoea Restore period, oestrogen Libido- testosterone Shrink tumour
Hyperprolactinaemia can cause?
Osteoporosis
