Lactation

Question 1

Prolactin is inhibited and stimulated by what?

Answer 1

Dopamine inhibits

TRH oxytocin and serotonin stimulate

Question 2

Lactational amenorrhoea?

Answer 2

Periods don’t continue whilst breast feeding

Question 3

High prolactin causes?

Answer 3

Dampen gnRH, low LH and FSH and low oestrogen and testosterone, hence lactational amenorrrhoea

Question 4

Oxytocin is synthesised?

Answer 4

Hypothalamic magnicellular neurons, supraoptic and paraventricular nuclei

Question 5

Presentation of hyperprolactinanemia?

Answer 5

Oligo/amenorrhoea, galactorrhoea and subfertility, erectile dysfunction decreased libido, visual symptoms, hypopituitarism

Question 6

Symptoms of prolactinaemia in men cause?

Answer 6

Visual symptoms, headaches, hypopituitarism, erectile dysfunction, decreased libido

Question 7

Causes of prolactinaemia?

Answer 7

Prolactinoma, non functioning adenoma, stress, drugs, PCOS, hypothyroidism, renal failure

Question 8

Drugs that increase prolactin?

Answer 8

Antidepressants antipsychotics, drugs used for nausea and vertigo (metocloperamide, domperidone and phenothiazine)

Question 9

Prolactinoma management?

Answer 9

Dopaminergic: cabergoline and bromocriptine

Side effects: fibrotic reactions pulmonary, pericardial
Psychiatric

Question 10

Side effects of prolactinoma drugs?

Answer 10

Fibrotic reaction, pulmonary pericardial (heart valves)

Psychiatric disturbances

Question 11

Milk production secretory initiation and activation hormones?

Answer 11

Progesterone for initiation and decreased progesterone and oestrogen for activation.

Activation- increase in prolactin, cortisol and insulin

Question 12

How does prolactin have a similar receptor to GH?

Answer 12

Due to tyrosine phosphorylation and JAK-STAT signalling

Question 13

Causes of hyperprolactinaemia?

Answer 13

Physiological, hpaa disease, drugs, stress, other conditions pcos, hypothyroidism, renal failure cirrhosis

Question 14

How do antidepressants and antipsychotics increase prolactin?

Answer 14

Inhibit secretion of dopamine, da antagonist and da receptor blocker, stimulation of seretonin

Question 15

Macro in pituitary is what size?

Answer 15

More than 1 cm

Question 16

Aims of Treatment for hyperprolactinaemia?

Answer 16

Restore fertility, stop galactorrhoea, restore periods and libido, shrink tumour

Question 17

Treatment for microprolmas?

Answer 17

Cocp or hormone replacement therapy, may involute postpartum

Question 18

How does a non functioning adenoma cause hyperprolactinaemia?

Answer 18

Compression of pituitary stalk cause disconnection/ hypothermic masses leading to no inhibition through dopamine

Question 19

Which hormone causes secretory initiation?

Answer 19

Progesterone

Question 20

What happens in secretory activation?

Answer 20

Drop in progesterone/ oestrogen
Increase in prolactin, cortisol and insulin

Copious milk production after 2/3 days

Question 21

Prolactin is similar to?

Answer 21

GH and has similar receptor and signalling such as tyrosine phosphorylation and JAK STAT signalling

Question 22

Issues with non-functioning adenoma?

Answer 22

Compressing pituitary stalk responsible for passage of dopamine hence medication wont work so hyperprlaemia

Question 23

What is the visual field called?

Answer 23

Humphreys test

Question 24

In post. Menopausal women LH and FSH are?

Answer 24

High

Question 25

how to treat non functioning pituitary adenoma?

Answer 25

Transphenoidal hypophysectomy

Question 26

What investigations should you do for high prolactin?

Answer 26

Pregnancy test
Renal function- u/e creatinine
Liver function test
Thyroid
Prolactin repeat
LH/FSH
Testosterone 
MRI pituitary

Question 27

What are the aims of prolactin treatment?

Answer 27

Restore fertility
Stop the stimulation, galactorrhoea
Restore period, oestrogen 
Libido- testosterone
Shrink tumour

Question 28

Hyperprolactinaemia can cause?

Answer 28

Osteoporosis