Chapter 6: Hyperprolactinemia, Galactorrhea, Pituitary adenoma
patient education with galactorrhea:
1. No breast stimulation 2. disclose all drugs being used
What serum lab tests would you order for these three disorders?
1. TSH (rule out Thyroid issue) 2. serum prolactin
What three symptoms may be present with pituitary adenoma?
1. breast secretions 2. menstrual changes 3. severe vascular headaches and blurred vision
When should galactorrhea be evaluated?
1. in a nullip 2. parous woman if 12 months since last pregnancy
Hyperprolactinemia is found in what percent of women with amenorrhea of unknown origin?
1/3, 33% will have high prolactin
What percentage of women with secondary amenorrhea have pituitary adenoma?
1/3, 33% will have pituitary adenoma
What would the prolactin level be if adenoma was strongly suspected?
100-300 ng/ml
Prolactin secreting adenomas account for what percent of pituitary adenomas?
50%
What is the treatment of choice for galactorrhea?
Bromocriptin, dopamine agonist which inhibits prolactin and decreases or stops galactorrhea
Symptoms of hyperprolactinemia/galactorrhea
Clear or milky bilat breast secretions
Definition of hyperprolactinemia
Elevated levels of prolactin
Can surgical treatment help>
If medical management has failed to relieve symptoms of adenoma, transphenoid surgery may help but recurrence rate is 10-70%
Any testing necessary for the breast secretions?
Microscopy, milk indicated by fat globules
Are there any overt physical findings with pituitary adenoma?
may have a normal physical and gynecologic exam with the exception of papillededma
What would the prolactin level have to be in order to refer out?
over 20 ng/ml
Definition of galactorrhea
secretion of nonphysiologic milky fluid from the breast, unrelated to pregnancy
Radiation therapy produces less satisfactory results than surgery
true, may take several years for prolactin level to fall and should be reserved for recurrences or those not responsive medical management
incidence of pituitary adenoma
unknown, rarely malignant, can grow for years
What will a funduscopic exam show if adenoma?
will show papilledema
If adenoma is the cause of galactorrhea, what symptoms will appear?
Visual disturbances and headaches
Which age group has the most pituitary adenomas?
Women younger than 40
A woman with a normal prolactin level (less than 20) who is not amenorrheic could be treated by:
Yearly prolactin levels
Can galactorrhea cause secondary amenorrhea in women?
Yes, but menses can also be normal or irregular
Would an MRI/CT scan help to diagnose?
Yes, ct scan or mri of the sella turcica would reveal or rule out adenoma
Would you perform UPT for these three disorders?
Yes, upt to rule out pregnancy
definition of pituitary adenoma:
benign tumor of pituitary, most common type secretes prolactin
