Prolactinoma

Question 1

Definition

Answer 1

Mammotroph cell line effected = HYPER prolactinaemia

Question 2

Epidemiology

Answer 2

Most common type of pituitary adenoma
FEMALES (20-50 years)
Male gender (30-60 years)

Question 3

Risk Factors

Answer 3

Genetic predisposition = presence of mutation resulting in MEN-2a/2b + familial isolated pituitary adenoma (FIPA)
Oestrogen therapy
Drugs - Ecstasy

Question 4

Aetiology

Answer 4

Mutation in lactotroph cells - Prolactinoma
Micro < 10mm
Macro > 10mm

Question 5

Pathophysiology

Answer 5

Anterior pituitary lactotroph tumours. Hypersecretion of prolactin which causes secondary hypogonadism via inhibitory effect on gonadotropin-releasing hormone (FSH + LH) + pituitary gonadotrophs. Normally dopamine is transported from the hypothalamus to the anterior pituitary via the hypophysial portal vessels where it inhibits prolactin secretion via dopamine receptors expressed by lactotrophs but where there is a distruption - hyperprolactinaemia

Question 6

Signs and symptoms

Answer 6

Women =
- Amenorrhoea
- Vaginal dryness
Men =
- Low libido
- ED
- Gynaecomastia + low testosterone
Both =
- Galactorrhoea
- Sexual dysfunction
- Bitemporal hemianopia

Question 7

Diagnosis

Answer 7

Serum prolactin high
MRI of Head = FIRST LINE + GOLD STANDARD
DNA testing - MEN-2a/2b + FIPA

Question 8

Treatment

Answer 8

Dopamine Agonist = CABERGOLINE
BROMOCRIPTINE
- Massively shrinks tumour
Transsphenoidal surgery