prolactinoma

Question 1

clinical features - effect of tumour and prolactin

Answer 1

Local effect of tumour – macro-adenoma
headache
visual field defect (bi-temporal hemianopia)
CSF leak (rare)

Effect of prolactin
menstrual irregularity/amenorrhoea
infertility
galactorrhoea
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 (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
• Galactorrhoea 🪐🌌
• 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)