Prolactinoma Flashcards
what is it?
physiologically dopamine inhibits the release of prolactin by the pituitary
prolactinoma is a prolactin secreting tumour (normally when prolactin is over 5000)
what causes raised prolactin?
physiological - breast feeding - pregnancy - stress - sleep drugs - dopamine antagonists e.g. metoclopramide - antipsychotics e.g. phenothiazines - antidepressants e.g. TCA, SSRIs - other, oestrogens, cocaine pathological - hypothyroidism - stalk lesions - iatrogenic or road accident - prolactinoma
how does it present in females?
early presentation galactorrhoea menstrual irregularity amenorrhoea infertility
how does it present in males?
late presentation
impotence
visual field abnormality
anterior pituitary malfunction
how is it investigated?
serum prolactin concentration - is it too high
MRI pituitary - features to look for, is it oversized
- microprolactinoma (<1cm)
- macroprolactinoma (>1cm)
- pituitary stalk
- optic chiasma
visual fields - bitemporal hemianopia (not homonymous hemianopia)
pituitary function tests - are other hormones affected - is there a deficiency in other pituitary hormones
how is it managed?
dopamine agonists
bromocriptine - 3 times per day oral
Quinagloide (norprolac) once per day oral
Cabergoline (Dostinex) - usually used - once to twice per week oral (lease side effects)
side effects
- nausea/vomiting
- low mood
- potential fibrosis (heart valves and retroperitoneal)