HYPERPROLACTINEMIA

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For those who DO NOT wish to conceive Prolactin level measured yearly Exogenous estrogen for those with low estrogen level Progesterone for thse with adequate estrogen

A Expectant treatment is...

Radiation therapy

Adjunt to txt of incomplet removal of pituitary tumor

Methyldopa

Blocks the conversion of tyrosine to dihydrocyphenylalanine

Prolactin

Both mammogrnic and lactogenic

Yes

Can the bromocriptine cross the placenta

Yes. Only if their is visual disturbance or severe headache

Could we give bromocriptine to pregnant women

Reserpine

Depletes catecholamines

True

Discontinue the bromocriptine once pregnancy occur

Antidepressant

Drug that block the dopamine uptake

Propanolol

Drug that blocks hypothalamic dopamine receptor

Anesthetics

Drug that would depelete hypotalamic circulation of dopamine and block binding sites

Anesthetics Antidepressant Antihypertensive Reserpine Methyldopa Propanolol OCP

Drugs that Stimulates prolactin

Bromocriptine for breastfeeding women who are attempting to stop Pergolide Cabergoline

Drugs that inhibit prolactin

Gonadotropin sex steroid function disorder Anovulation Inaappropriate lactation/galactorrhea

Effects of hyperprolactinemia

Oligomenorrhea/amenorrhea Anovulation Galactorrhea

Effects of hyperprolactinemia

Estrogen

Enhances the effect of TRH and inhibit dopamine

Dopamine

Estrogen inhibits what..

Stimulate the growth of mammary tissue Prduce and secrete milk into the alveoli

Functions of prolactin

Sample collection Breast palpation that express any secretion + multiple fat globules/droplets under LPF MRI CT SCAN PRL

How can you diagnose galactorrhea

By liver and kidneys

How is the prolactin cleared

>20-25 ng

Hyperprolactinemia mesure of prolactin

False. Benign

Hyperprolactinemia with or without microadenoma is malignant

Craniopharyngioma Hypothalamic sarcoidosis Histiocytosis Leukemia Carcinoma

Hypothalamic causes that laters the portal circulation of dopamine

Macroadenoma Anovulatory Wish to conceive

Indication of dopamine receptor agonist

Macroadenomas who fail with medical tx Poor compliance

Indication of operative approach

Dopamine

Inhibit prolactin

Benign

Is the Primary empty sella syndrome fatal or benign

Stimulatory

Is trh inhibitory or stimulatory to PRL secretion

Prolactinoma

It arise from a sing,e mutation with clonal proliferation of lactotrophs

Bromocriptine

It is a dopamine agonist that directly stimulates dopamine receptor thus inhibiting prolactin secretion and release

Inhibition

Major control mechanism is....

Ecxpeftat treatment Medical therapy Operative approach Radiation therapy

Management of galactorrhea

Multiple fat globules/droplets

Microscopic finding of galactorrhea

Prolactinoma

Most common pituitary cause of hyperprolactinemia

Stress

Most frequent cause of hyperprolactinemia because it decreases dopamine

Galactorrhea

Non puerperia secretion from the breast of waterh or milky fluid No pus and blood

8ng

Normal prolactin

Nipple stimulation Exercise (serotonin) Sleep Ff ingestion ofnoonday meal Stress - most frequent Primary hypothyroidism

Physiologic stimuli of hyperprolactinemia that may cause a false positive result

Pituitary tumors Lactotroph hyperplasia Empty sella syndrome

Pituitary causes

Lactotroph hyperplasia

Pituitary enlargement with supra sellar extension which cant be distinguised from microadenoma and x by piujtary exploration

Primary empty sella syndrome

Primary empty sella syndrome Defect in the sella diaphragm thatballows the subarachnoid membrane to herniate into the sella turcica

Serotonin

Principal realeasing factor

Hyperprolactinemia

Prolactin in a non pregnant state

Dopamine

Regulator of prolactin

Hypotension Nausea Vomiting Nasal congestion Diarrhea Fatigue Constipation

Side effects of bromocriptine

microadenoma <1cm macroadenoma >1cm

Size of microadenoma and macroadenoma

Serotonin TRH estrogen

Stimulates prolactin

Dopamine

Stress will increase what in relation to hyperprolactinemia

Amenorrhea and galactorrhea

Symptoms of Primary empty sella syndrome

Primary hypothyroidism Renal diseas CNS DIsoderes Piyuitary tumor, most common cause Lactotroph hyperplasia Primary empty sella syndrome

Systemic causes of hyperprolactinemia

Pregnancy is desired : bromocriptine Low estrogen level : OCP

Therapyof prolactinoma is not necessary unless what?

False. Poor prognosis

There is a high cure rate for women above 26yo with amennorrhea for about 6months. True or false

False. Cure rate is indirectly proportional to the amount of prl. More prl, lesser cure rate

There is a high cure when the prolactin level is >300ng/ml true or false

1-3hrs later 14hrs

When in the peak blood level of bromocriptine? What is the duration?

Dopamine

This directly act in the receptors in the lactotrophs of the pituitary gland

Bromocriptine

This drug reduces tumor size by 80-90% so it is the initial management with prl-secreting macroadenomas

Galactorrhea

This is a non puerperial secretion from the breast of watery or milky fluid, contains no pus or blood

Radiation therapy

This is only used as an adjunct for removal of large tumor but can cause damage to the normal pituitary function, abnormal function and damage to optic nerve

Primary empty sella syndrome

This is the distortion of infundibuoary stalk and causes compression of pituitary gland and enlarged sella turcia

Nighttime while asleep Afternoon

Time of the day that prolactin is maximal When is minimal?

Serotonin TRH estrogen

Timilating and releasing factors of prolactin

True

Treat hyperprolactinemia only when pregnancy is desired

False. Normal function but HYPERPROLATINEMIA

True or false, there is normal pituititary function but with hypoprolactinemia

False. Only 20% of pts

True or false. All those have galactorrhea have prolactinoma distinguished in radiolog

False. Only 50%

True or false. All those have hyperprolactinemia have prolactinoma

Decidua Kidney Hypothalamus Intestinal tract cells Lungs

What atpre the extra pituitary sites of synthesis

Increase prl will interefere with positive effect on midcycle LH release and there would be abnormal frequency and amplitude of LH pulsation

What happens in increase PRL that cause anovulation

Prl will inhibits gonadotropin release

What happens in increase PRL that cause oligomenorrhea and amenorrhea

Decreased dopamine to reach the pituitary

What happens to dopamine when there is Primary empty sella syndrome

Estrogen

What inhibit hypothalamus and pituitary to produce mor gonadotropin hormones

MRI Then CT

What is the best diagnosticfor Primary empty sella syndrome

Decrease metabolic clearance And incra Ease production rate (cause is unknown)

What is the effect of renal disease to prolactin

Transphenoidal microsurgical resection of prolactinoma

What is the operative approach in prolactinoma

Estrogen and progesterone

What stimulates uterus

Chromophobe or lactotroph cell in the pituitary

What sunthesizes the prolactin and where?


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