Neoplasms

Question 1

two types of tumours

Answer 1

microadeoma <1cm/1cm

macro adenoma >1cm

Question 2

three main categories of raised prolactin

Answer 2

physiological
pharmacological
pathological

Question 3

physiological causes of raised prolactin

Answer 3

breast feeding
pregnancy
stress
sleep

Question 4

pharmacological causes of raised prolactin

Answer 4

• dopamine antagonists e.g. metoclopramide
• antipsychotics e.g. phenothiazines
• antidepressants e.g. TCA, SSRIs, oestrogen and cocaine

Question 5

pathological causes of raised prolactin

Answer 5

hypothyroidism (dopamine requires tyrosine- thyroxine is made from tyrosine and iodine)
stalk lesions (iatrogenic and RTA)
prolactinoma

Question 6

define prolactinoma

Answer 6

adenoma of the pituitary gland that overproduces prolactin

Question 7

presentation of prolactinoma in females

Answer 7

early presentation due to more obvious symptoms
galactorrhea
menstrual irregularity
amenrrohoea
infertility

Question 8

presentation of prolactinoma in males

Answer 8

late 
impotence
visual field abnormality
headache
anterior pituitary malfunction

Question 9

diagnosis of prolactinoma

Answer 9

too much= serum prolactin concentration
too big= MRI (macroprolactinoma, microprolactinoma, pituitary stalk and otic chiasm)
visual field e.g. bitemporal hemianopia
too little= PFTs for other hormones

Question 10

how high is prolactin in macroprolactinoma

Answer 10

20,000+

Question 11

how high is prolactin in microprolactinoma

Answer 11

3,000+

Question 12

management of prolactinoma

Answer 12

dopamine agonists e.g. cabergoline

cause tumour shrinkage

Question 13

adverse of dopamine agonists e.g. cabergoline

Answer 13

nausea
vomiting
low mood
fibrosis of heart valves and retroperitoneum