Hyperprolactinaemia

Question 1

What is Hyperprolactinaemia?

Answer 1

Condition of high Prolactin in blood

Question 2

Does Hyperprolactinaemia present early / late in men / women?

Answer 2

• Early in women (menstrual disturbances)
• Late in men (erectile dysf)

Question 3

What are the causes of Hyperprolactinaemia? (3 things)

Answer 3

1. Excess prod by pituitary (e.g PROLACTINOMA)
2. Disinhibition by pituitary stalk compression –> reducing dopamine levels (dopamine inhibits prolactin secretion)
3. Using a dopamine antagonist (reducing dopamine levels)

Question 4

What are the pathophysiological steps of Hyperprolactinaemia? (4 things)

Answer 4

1. High levels of Prolactin
2. Inhibits Gonadotropin Releasing Hormone (GnRH) secretion
3. Low FSH / LH / Oestrogen / Testosterone
4. Hypogonadism / Infertility / Osteoporosis

Question 5

What drugs are Dopamine antagonists (and hence cause Hyperprolactinaemia)? (5 things)

Answer 5

1. Metoclopramide (anti-emetic)
2. Haloperidol (anti-psychotic)
3. Methyldopa (anti-HTN)
4. Oestrogens
5. MDMA / ecstasy

Question 6

What is a reason for non-compliance of anti-psychotics (e.g haloperidol) in relation with Hyperprolactinaemia? (3 steps)

Answer 6

1. Anti-psychotics = dopamine antagonists
2. Cause Hyperprolactinaemia
3. This causes: Reduced libido / Anorgasmia / Erectile dysf

Question 7

What are the CF of Hyperprolactinaemia in WOMEN? (6 things)

Answer 7

1. Reduced libido
2. Galactorrhoea
3. Dry vagina
4. Amenorrhoea / oligomenorrhoea
5. Infertility
6. Weight gain

Question 8

What are the CF of Hyperprolactinaemia in MEN? (4 things)

Answer 8

1. Reduced facial hair
2. Galactorrhoea
3. Erectile dysf
4. Osteoporosis (late)

Question 9

What investigations should you do for sus Hyperprolactinaemia? (5 things)

Answer 9

1. Basal test for Prolactin levels (venepunctre between 9am - 4pm)
2. Pregancy test
3. Thyroid function test
4. UnEs
5. MRI pituitary (if all other causes defo ruled out)

Question 10

Why should you do Thyroid function test (alongside Basal Prolactin levels test) for someone with sus Hyperprolactinaemia (aka amenorrhoea)?

Answer 10

Pt w ABN TSH levels + NORMAL Prolactin = Thyroid disease

To rule out Thyroid disease bc present similarly (amenorrhoea)

Question 11

Why should you do a pregnancy test for sus Hyperprolactinaemia?

Answer 11

Could just be skipping periods because pregnant

Question 12

What are the management options for Hyperprolactinaemia? (2 things)

Answer 12

1. Dopamine agonists (e.g Bromocriptine / Cabergoline) (FIRST LINE)
2. Treat underlying cause:

• Surgery for Prolactinoma tumour (trans-sphenoidal)
• Discontinue Dopamine antagonists

Bromance or Cabbage to crip the milk lol

Question 13

What do Dopamine agonists do in Hyperprolactinaemia? (3 things)

Answer 13

1. Reduce Prolactin secretion
2. Restore menstrual cycles
3. Reduce tumour size

Question 14

What should be done for a pt treated for Hyperprolactinaemia? (2 things)

Answer 14

1. Can decrease medication after 2 years
2. BUT regular follow up bc Hyperprolactinaemia recurrence / tumour expansion

• MRI + check visual fields (if headache + visual loss)