prolactinoma

Question 1

clinical features - effect of tumour and prolactin

Answer 1

Local effect of tumour:
- headache
- bi-temporal hemianopia
- CSF leak (rare)

Effect of prolactin:
- menstrual irregularity/amenorrhoea
- infertility
- galactorrhoea - leak of milk from nipple
- low libido
- low testosterone in men

Question 2

Management of prolactinoma

Answer 2

Unlike other pituitary tumours management is medical rather than surgery

dopamine agonist - cabergoline

• macroadenoma unlikely to change
• microadenoma will be fine

Question 3

Aetiology of hyperprolactinemia - high prolactin (2)

Answer 3

• Prolactinoma
• Drugs (ecstacy)

Question 4

Best treatment for hyperprolactinemia (2)

Answer 4

• Dopamine agonists eg: cabergoline or bromocriptine
• Massively shrinks prolactinoma (tumour) as dopamine is an inhibitor of prolactin

Question 5

Link between acromegaly and prolactinoma

Answer 5

50% of acromegaly tumours are associated with prolactinoma

Question 6

Symptoms of hyperprolactinoma (4)

Answer 6

• Secondary amenorrhoea - absence of 3 or more periods in a row
• Galactorrhoea - abnormal milk release
• Sexual dysfunction (M+F)
• Gynecomastia, low testosterone

Question 7

What are Dopamine agonists (3) and antagonists (3) used for?

Answer 7

• Agonists, used in prolactinoma, acromegaly and early in Parkinson’s
• Antagonists often for nausea and vomiting (eg: metoclopramide, antiemetic) + for psychiatric disorders (eg: haloperidol)

Question 8

Diagnosis of hyperprolactinemia (3)

Answer 8

• High serum prolactin
• > 1000mIU/L
• or 500-1000mIU/L on two occasions

Question 9

Risk factors for hyperprolactinaemia (2)

Answer 9

• Females
• High serum prolactin (released from lactotrophs in the ant. pituitary)

Question 10

prolactinoma

Answer 10

a benign tumor of the pituitary gland that produces a hormone called prolactin

Question 11

first dopamine agonist

Answer 11

cabergolin

Question 12

second dopamine agonist

Answer 12

bromocriptine