Prolactinoma Flashcards
There are a range of causes.
Dopamine inhibits release of prolactin. Any medications that reduce dopamine will obviously begin to allow increased prolactin production. What meds reduce dopamine levels?
What normal physiological process will cause an increase in prolactin?
What could cause reduced PRL elimination?
What could cause increased PRL production?
How would primary hypothyroidism cause this?
Neuroleptics
Antihypertensives - CCB’s
Psychotropic agents - TCA’s
Pregnancy (Stress, sexual intercourse, nipple stimulation and suckling also increase PRL)
Renal failure
Hepatic insufficiency
PCOS
Pituitary tumours - adenomas, hypophysiitis
Because low thyroid hormone levels stimulates the pituitary gland to make more TRH. This stimulates more prolactin release.
General features:
What is the main effect? - think about what PRL is for
What other features may they have? - they are all linked to the reproductive system and fertility
What effect would the mass effect of a tumour cause?
Galactorrhea - discharge from the breast
Menstrual abnormalities Decreased libido ED Infertility Gynaecomastia
Hypopituitarism
Headache
VF defects
CN Palsies
Diagnosis is just testing hormones and MRI as always!
Diagnosis is just testing hormones and MRI as always!
Management is just addressing the effects of the excess prolactin hormone and resolving the issue.
Who can you refer them to?
What drug can be prescribed to inhibit the pituitary gland’s production of PRL?
Why is a visual field assessment needed with a macro adenoma - a big tumour basically?
Pituitary MDT
Dopamine agonist
Because it can compress the optic chiasm leading to visual field defects
