Lactation, galactorrhoea, prolactinomas Flashcards
What are the different stages to lactogenesis
Secretory initiation
- stimulated via progesterone
- occurs during pregnancy
- colostrum (first batch of milk with antibodies)
secretory activation
- decreased progesterone/ oestrogen
- increased prolactin (cortisol, insulin)
- copious milk production after delivery (2-3 days post partum)
What breast milk composed of
- sugar e.g. lactose
- milk fats e.g. tgc, cholesterol, phospholipids, steroid hormones
- minerals e.g. Na, K, Cl, Ca, Phosphate
- growth factors
- cellular components e.g. macrophages, lymphocytes etc
What is galactopoiesis and what type of feedback loop is it and what are the 2 principal hormones that control lactation
It is lactation, a positive feedback loop
regular removal of milk and nipple stimulation increases milk production.
Prolactin (adenohypophysis)
Oxytocin (neurohypophysis)
What hormones stimulate and inhibit prolactin production
stimulated- serotonin
inhibited- dopamine
What is lactational amenorrhoea
Period of time where the woman is breastfeeding and the period doesn't resume because: increased prolactin -----> -- decreased GnRH -- decreased LH and FSH -- decreased oestrogen/ testosterone
How does hyperprolactinaemia present in women
oligo/ amenorrhoea
- galactorrhoea
- subfertility
- may not have all these symptoms
How does hyperprolactinaemia present in men
Erectile dysfunction
- decreased libido
- Visual symptoms
- headaches
- hypopituitarism
- galactorrhoea
What are some causes of hyperprolactinaemia
Physiological
-pregnancy, lactation
hypothalamic-pituitary disease - non-functioning adenoma drugs stress other: Hypothyroidism, renal failure, PCOS
What are some drugs that increase Prolactin
Antidepressants/ antipsychotics
drugs for nausea and vertigo
mechanisms- inhibition of secretion/ action of dopamine
What are some investigations for hyperprolactinaemia
- Pregnancy test
- renal function
- liver function tests
- thyroid function
- prolactin
- LH, FSH
- testosterone (men)
MRI pituitary and adenohypophysis function tests
What are the aims of treatment for hyperprolactinaemia
Restore fertility
stop galactorrhoea
-restore regular menstrual periods/ libido: oestrogen/ testosterone use
shrink the tumour (macroadenoma)
What is an NFA and how is it managed
Non-functioning pituitary adenoma
-compression of the infundibulum
may need surgery or radiotherapy
