Prolactinoma Flashcards

1
Q

what is the typical presentation of a prolactinoma?

A

Secondary amenorrhoea, galactorrhoea, decreased libido, low GnRH, loss of pubic hair, bitemp hemianopia

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2
Q

define a prolactinoma?

A

A pituitary adenoma(benign lactotroph adenomas) that overproduces prolactin.

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3
Q

what are the 4 different types of prolactinoma?

A

Microadenomas: < 1 cm

Macroadenomas: > 1 cm

Giant Pituitary Adenomas: > 4 cm

Malignant Prolactinoma (RARE)

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4
Q

outline the aetiology of prolactinoma?

A

Cause if UNKNOWN

Some may occur as a consequence of MEN 1 syndrome

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5
Q

what is a risk factor for prolactinoma?

A

RISK FACTOR OF TUMOUR ENLARGEMENT IN PREGNANCY

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6
Q

Summarise the epidemiology of prolactinoma

A

Relatively common

Higher incidence in premenopausal women

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7
Q

What are the symptoms and signs of prolactinoma which are caused by the tumour size?

A

Headache

Visual disturbance (bitemporal hemianopia)

Cranial nerve palsies

Signs and symptoms of hypopituitarism

NOTE: microprolactinomas rarely expand to become macroprolactinomas

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8
Q

what are the symptoms and signs of prolactinoma in women?

A

Amenorrhoea/oligomenorrhoea

Galactorrhoea

Infertility

Hirsuitism

Reduced libido

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9
Q

what are the symptoms and signs of prolactinoma in men?

A

Symptoms are subtle and develop slowly

Reduced libido

Reduced beard growth

Erectile dysfunction

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10
Q

what are the appropriate investigations for prolactinoma?

A

Exclude pregnancy

Serum prolactin level (extremely high levels (> 5000 mU/L) suggests true prolactinoma)

Also check TFTs- hypothyroidism –> high TRH –> stimulates prolactin release

MRI – esp if visual defect is noted

Assessment of pituitary function

Computerized visual field exam

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11
Q

what are the complications of prolactinoma?

A

Complications of hypogonadism

  • Osteoporosis
  • Reduced fertility
  • Erectile dysfunction

Complications of tumour size

  • Visual loss
  • Headache
  • Pituitary apoplexy
  • CSF rhinorrhoea
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12
Q

Summarise the prognosis for patients with prolactinoma

A

Microprolactinomas will spontaneously resolve in about 1/3 cases

Dopamine agonist withdrawal is usually attempted after about 2-3 years if prolactin levels have normalised and tumour volume is reduced

High rates of recurrence

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13
Q

what is the medical treatment of prolactinoma?

A

CABERGOLINE and BROMOCRIPTINE- dopamine agonists

- dopamine acts as a brake on prolactin production

  • Effective in most patients
  • Cabergoline is used first line due to better efficacy and reducing tumour size and better tolerability
  • Usually need to be continued on a long-term basis
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14
Q

what is the management if dopamine agonists are innfective

A

ONLY IF RESISTANT TO MED TREATMENT

Surgery – transphenoidal

Radiotherapy – rarely used – only if meds and surgery have failed

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