Hyperprolactinemia

Question 1

what is a physiological cause of hyperprolactinemia?

Answer 1

pregnancy

Question 2

what can cause a lactating woman to have increased prolactin? (2)
what causes it?

Answer 2

nipple stimulation
breast exams

dopamine suppression

Question 3

what pathological condition can lead to increased prolactin? (2)

Answer 3

prolactinomas
dopamine suppression

Question 4

what pathological conditions can cause increased prolactin due to a decrease in excretion of prolactin? (2)

Answer 4

hepatic or renal dysfunction

Question 5

what is the most common cause of pharmacologic hyperprolactinemia?

Answer 5

classic/typical antipsychotics (dopamine receptor antagonists)

Question 6

what are some symptoms of hyperprolactinemia in men? (5)

Answer 6

decreased libido
erectile dysfunction
infertility
gynecomastia
+/- galactorrhea

Question 7

what are some symptoms of hyperprolactinemia in women? (3)

Answer 7

amenorrhea/oligomenorrhea
infertility
galactorrhea

Question 8

what should serum prolactin in men and postmenopausal women be if they have hyperprolactinemia?

Answer 8

over 20

Question 9

what should serum prolactin in premenopausal women be if they have hyperprolactinemia?

Answer 9

over 30

Question 10

what should be done with slightly elevated labs in a patient with suspected hyperprolactinemia?

Answer 10

repeat labs fasting

Question 11

in a patient with hyperprolactinemia, what should be ordered to test for pregnancy?

Answer 11

serum hCG

Question 12

in a patient with hyperprolactinemia, what should be ordered to test for hypothyroidism?

Answer 12

free T4
TSH

Question 13

in a patient with hyperprolactinemia, what should be ordered to test for renal disease?

Answer 13

BUN/creatinine

Question 14

what imaging can be done for a patient with hyperprolactinemia?

Answer 14

pituitary MRI

Question 15

in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is a somatotroph adenoma?

Answer 15

IGF-1

Question 16

in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is a corticotroph adenoma?

Answer 16

plasma ACTH

Question 17

in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is hyperparathyroidism?

Answer 17

serum calcium

Question 18

in a patient with hyperprolactinemia and a positive mass lesion in the sella turcica, what test will indicate it is male/female hypogonadism?

Answer 18

testosterone (M)
estrogen (F)
FSH
LH

Question 19

What are 3 reasons we would treat hyperprolactinemia?

Answer 19

chiasmal symptoms d/t mass effect
hypogonadism d/t gonadotropin secretion suppression
bothersome galactorrhea

Question 20

what medication should be started in a patient with hyperprolactinemia if hypothyroidism is diagnosed?

Answer 20

levothyroxine

Question 21

what is the first line medication for prolactinoma? (2)

Answer 21

dopamine agonist:
cabergoline
bromocriptine

Question 22

what is important for a patient to know when being treated for a prolactinoma?

Answer 22

symptoms will return if medication is stopped

Question 23

what is the 2nd line treatment for a prolactinoma in a women wishing pregnancy or a patient that does not tolerate the medication?

Answer 23

transphenoidal pituitary surgery

Question 24

what is the 3rd line treatment for a prolactinoma?

Answer 24

radiation therapy