prolactinoma Flashcards

1
Q

define prolactinoma?

A

a pituitary adenoma that overproduces prolactin

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2
Q

how can prolactinomas be catagorised?

A
either by size 
o	Microadenomas: < 1 cm  
o	Macroadenomas: > 1 cm  
o	Giant Pituitary Adenomas: > 4 cm  
o	Malignant Prolactinoma (RARE) 
or by hormonal status 
o	Functioning adenoma (produces hormone) 
o	Non-functioning adenoma (does not make hormone)
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3
Q

what are the risk factors of a prolactinoma?

A

o Risk of tumour enlargement in pregnancy

o MEN 1 syndrome

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4
Q

epidemiology of a prolactinoma?

A
  • Relatively common

* Higher incidence in premenopausal women

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5
Q

presenting symptom of a prolactinoma in women?

A
o	Amenorrhoea/oligomenorrhoea  
o	Galactorrhoea  
o	Infertility  
o	Hirsuitism  
o	Reduced libido
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6
Q

presenting symptoms of a prolactinoma in men?

A

o Symptoms are subtle and develop slowly
o Reduced libido
o Reduced beard growth
o Erectile dysfunction

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7
Q

what symptoms are caused by large tumour?

A

o Headache
o Visual disturbance
o Cranial nerve palsies
o Signs and symptoms of hypopituitarism

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8
Q

what is the gold standard investigation for prolactinoma?

A

• MRI

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9
Q

what other investigations are necessary?

A
•	Exclude pregnancy  
•	Serum prolactin level 
o	Normal = <500mlU/l
o	Very high = 6000mlU/l
•	TFTs 
•	Assessment of pituitary function
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10
Q

first line treatment for prolactinomas?

A

• Dopamine Agonists (e.g. cabergoline and bromocriptine)

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11
Q

what is recommended if the patient cannot tolerate a dopamine agonist?

A

trans-sphenoidal approach

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12
Q

what are the complications of a prolactinoma?

A
•	Complications of hypogonadism 
o	Osteoporosis  
o	Reduced fertility  
o	Erectile dysfunction  
•	Complications of tumour size 
o	Visual loss  
o	Headache  
o	Pituitary apoplexy  
o	CSF rhinorrhoea
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13
Q

prognosis?

A
  • Micro-prolactinomas will spontaneously resolve in about 1/3 cases
  • High rates of recurrence
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