Pituitary Disease - Hyperprolactinaemia

Question 1

Clinical Features of Hyperprolactinaemia in Men (2).

Answer 1

1. Erectile Dysfunction.

2. Reduced Facial Hair.

Question 2

Clinical Features of Hyperprolactinaemia in Women (4).

Answer 2

1. Oligo/Amenorrhoea.
2. Galactorrhoea.
3. Infertility.
4. Vaginal Dryness.

Question 3

Clinical Features of Hyperprolactinaemia - Mass Effects (2).

Answer 3

1. Headache.

2. Visual Field Defect - Bitemporal Hemianopia or Upper Temporal Quadrantanopia.

Question 4

Investigations of Hyperprolactinaemia (2).

Answer 4

1. MRI Brain.

2. Serum Prolactin.

Question 5

Macroadenoma vs. Microadenoma (2).

Answer 5

1. Macroadenoma = >10mm and appears as a Space-Occupying Tumour on MRI.
2. Microadenoma = <10mm and appears as a lesion in the Pituitary.

Question 6

Management of Prolactinoma (4).

Answer 6

1. Dopamine Agonist e.g. Cabergoline to result in reduced Serum Prolactin, stop galactorrhea and restore gonadal function.
2. HRT.
3. Trans-Sphenoidal Resection.
4. Radiotherapy.

Question 7

Aetiology of Raised Prolactin (8).

Answer 7

1. Prolactinoma (commonest).
2. Pregnancy.
3. Oestrogens.
4. Stress, Exercise, Sleep.
5. Acromegaly.
6. PCOS.
7. Primary Hypothyroidism.
8. Drugs.

Question 8

Give 4 drugs that can raise Prolactin levels.

Answer 8

1. Metoclopramide, Domperidone.
2. Phenothiazines.
3. Haloperidol.
4. SSRIs and Opioids.