Lactation, galactorrhoea, prolactinoma Flashcards
Prolactin levels during pregnancy and breastfeeding
Rises during pregnancy
- Stimulates duct and lobule development in breast
- Develops acini [secretory units]
Lactational amenorrhoea
Lack of menstrual periods during breastfeeding
- High prolactin levels dampens the gonadal axis.
- Inhibits GnRH, LH, FSH, oestrogen/progesterone
Oxytocin and lactation
Stimulates milk let down
- Contraction of smooth muscle in the breast [myoepitheium]
Positive feedback
- Stimulation of the nipples/ pavlovian reflex
Benefits of mammals lactating
Production of nutritious secretion
- Helps development both in brain and body
Hormones released helps to develop the ‘maternal’ aspect of the mother’s brain.
- Metabolic and psycho-social behavioural
Hyperprolacteraemia
- Presentation in women
Amenorrhoea/ oligomenorrhoea
Galactorrhea
Sub-fertility
- Increases osteoporosis risk
Can present after contraceptive pill but is coincidental
Hyperprolacteraemia
- Presentation in men
Presents later due to the non-specific symptoms
Erectile dysfunction [prolactin dampening gonadal axis]
Decrease in libido
Larger adenomas
- Visual defects
- Hypopituitary
- Headaches
Rarer
- Gynecomastia
- Galactorrhea
Causes of hyperprolacteraemia
Physiological
- Pregnancy
- Lactation
Hypothalamico-pituitary
- Prolactinomas
- Non-functioning adenoma
Drugs
Stress [increases when stressed, like cortisol]
Poly cystic ovarian syndrome
Renal failure
Cirrhosis
Drugs that increase prolactinoma
Antidepressants
Antipsychotics
Drugs for nausea and vertigo
- Phenothiazine
- Domperidone
- Metoclopramide
Investigations into prolactinoma
Pregnancy tests
Renal function
Liver function tests
Repeating prolactin test [incase it was stress]
LH. FSH
Testosterone in males
MRI pituitary
Visual tests and anterior pituitary function [macroadenoma]
Aims of treating prolactinoma
Restore fertility
Stop galactorrhoea
- Stocking nipple stimulation/ checking oxytocin
Restore menstrual periods/ libido [and bone strength]
- Hormone treatment [oestrogen/ testosterone]
Shrinking macroadenoma
Drugs to treat macroprolactinoma
- Include side effect
Dopaminergic drugs
- Cabergoline
Shrinks macroadenoma and preserves pituitary function
Rare
- Fibrotic reaction [pulmonary, pericardial, retoperitoneal]
- Psychiatric disturbance.
Drugs to treat microprolactinoma
Hormonal therapy if fertility is not required
- Then discontinue during pregnancy and give cabergoline
Non functioning pituitary adenoma treatment
If compressing pituitary stalk
- Surgery and radiotherapy
Pituitary still monitored with MRI and visual field assessment
- Dopaminergic drugs will decrease prolactin
Breast development
- Puberty
- Pregnancy
- Breastfeeding
Puberty
- Increase in oestrogen, progesterone, GH
- Alveolar buds and lobules increased
Pregnancy
- Oestrogen, progesterone increases
- As well as hCG and prolactin
- Increases alveolar development–> colostrum accumulate
Breastfeeding
- Copious milk production
Milk composition
Sugar
Milk fats
Proteins
Minerals
Growth factors
Cellular components
- Immune cells
- Phospholipids
