Hyperprolatinaemia

Question 1

What normal conditions would cause high prolactin in blood?

Answer 1

• Pregnancy
• Lactation
• Severe stress

Question 2

What are prolactinomas?

Answer 2

• prolactin-producing tumours of the pituitary gland

Question 3

What is the physiology of prolactin?

Answer 3

• Produced by lactotroph cells of APG
• Under inh. control of dopamine

Question 4

What stimulates prolactin production?

Answer 4

• dopamine receptor antagonists
• thyrotropin-releasing hormone (TRH)
• vasoactive intestinal peptide (VIP) or epidermal growth factor
• suckling by an infant

Question 5

What extra pituitary glands produce prolactin too?

Answer 5

• adipose tissue
• immune cells
• hair follicle

Question 6

What are the effects of raised prolactin?

*think in women and men

Answer 6

Women

1. inhibits gonadotrophin secretion- FSH and LH
2. menstrual dysfunction & galactorrhoea

Men

1. direct, reversible effect on the hypothalamus
2. secondary hypogonadism
3. reduced libido and erectile dysfunction

Question 7

What are the common causes of hyperprolactinemia?

Answer 7

• Prolactinoma
• Hypothyroidism
• Antipsychotics

Question 8

What are the causes of hyperprolactinaemia?

*think physiological, intracranial, endocrine, drugs

Answer 8

Physiological

• Pregnancy
• Puerperium
• breast stimulation

Intracranial

• Pituitary tumours
• Head injury - disrupting pituitary stalk
• Brain surgery
• Post ictal

Endocrine

• Hypothyroidism
• Cirrhosis
• Cushings
• Polycystic Ovary syndrome

Drugs

• Dopamine receptor antagonist (Domperidone, metoclopromide)
• Dopmaine depleting agents (methyldopa)
• Antidepressant (TCA, MOA inh. SSRI)

Question 9

What are the prolactinoma classification?

Answer 9

• Microadenomas: <10 mm. (very common)
• Macroadenomas: >10 mm.
• Giant pituitary adenomas: >40 mm. (more common in men than women)
• Malignant prolactinomas (very rare)

Question 10

What is the most common hormone secreting pituitary tumour?

Answer 10

• Prolactinoma

Question 11

What are the clinical presentation of hyperprolactinaemia?

*think women, men, children, and tumour size

Answer 11

Women

• amenorrhoea
• galactorrhoea
• infertility
• low libido

Men

• low libido
• erectile dysfunction
• reduced beard growth
• gynaecomastia

Child

• delayed puberty

Tumour size

• Headache\bitemporal heminopia
• cranial nerve palsies
• hypopituitarism

Question 12

What Ix would you order for Hyperprolactinaemia?

Answer 12

• TFTs
• exclude pregancy
• serum prolactin
  
  • *venepuncture can increase prolactin

Further testing

• Visual field
• MRI
• Assess pituitary function

Question 13

How would you mx hyperprolactinaemia?

Answer 13

• Asymptomatic with hyperprolactinaemia +/- prolactinoma
  
  • No Tx
  • Majority of tumour x inc. size
• Dopamine agonist
  
  • Cabergoline
  • Bromocriptine
• If DA ineffective
  
  • Surgery

Question 14

When should prolactinomas be treated?

Answer 14

• Adverse effects of tumour size.
• Adverse effects of hyperprolactinaemia.

Question 15

What precautionary measures to take when administering Dopamine Agonist?

Answer 15

Exclude

• cardiac valve fibrosis
• pulmonary fibrosis

Question 16

What are the SE of DA?

Answer 16

• excess or sudden sleepiness
• pathological gambling
• binge eating

Question 17

What risk do pregnancy carry in prolactinoma?

Answer 17

• tumour enlargement

Question 18

What features in pregnancy would prompt you for urgent referral?

Answer 18

• headaches
• visual distrubance

Question 19

What are the cx of Hyperprolactinaemia?

Answer 19

• osteoporosis
• reduced fertility
• erectile dysfunction
• visula loss
• headache