HYPERPROLACTINEMIA
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?