22.) Hyperprolactinemia Flashcards
(15 cards)
What is hyperprolactinemia?
Hyperprolactinemia is the increased production of prolactin by the anterior pituitary.
Normal levels under 20ng/ml
When can hyperprolactinemia occur physiologically?
It can occur during pregnancy, lactation, and periods of stress.
What is the most common cause of pathological hyperprolactinemia?
Pathological hyperprolactinemia is most often the result of pituitary adenomas.
What is the physiological effect of increased prolactin?
↑ Prolactin → ↑ central dopamine (prolactin-inhibiting hormone) → suppression of GnRH → ↓ LH, ↓ FSH → ↓ estrogen, ↓ testosterone → hypogonadotropic hypogonadism.
What are the causes of hyperprolactinemia?
Causes include prolactinomas, severe primary hypothyroidism (TRH high stim prolactin ) drugs, and chronic renal failure.
Pregnancy
Stress
Breastfeeding
Sleep
What are prolactinomas?
Prolactinomas are prolactin releasing adenomas.
How does severe primary hypothyroidism affect prolactin levels?
Severe primary hypothyroidism causes ↓ T3/T4 → ↑ TRH → ↑ prolactin.
What types of drugs can cause hyperprolactinemia?
Dopamine antagonists (e.g., metoclopramide, haloperidol), dopamine synthesis inhibitors (e.g., alpha methyldopa), and oral contraceptives.
What are the clinical effects of hyperprolactinemia in men?
Men may experience hypogonadism, decreased libido, infertility, impotence, and galactorrhea or gynecomastia.
What are the clinical effects of hyperprolactinemia in premenopausal women?
Premenopausal women may have menstrual irregularities, amenorrhea, anovulation, infertility, decreased libido, and risk of osteoporosis.
What are the steps for diagnosing hyperprolactinemia?
- Elevated serum prolactin level. 2. Order a pregnancy test and TSH level for differential diagnosis. 3. CT scan or MRI to identify any mass lesions.
What is the treatment for hyperprolactinemia?
Treat the underlying cause, which may include transsphenoidal resection, discontinuing offending drugs, treating hypothyroidism, or renal transplant.
Dop aganoist ( Cabergoline )
What are the dopamine agonists used in the treatment of hyperprolactinemia?
Dopamine agonists are the treatment of choice, such as cabergoline and bromocriptine.
What is the initial dose of cabergoline?
The initial dose of cabergoline is 0.5 mg a week.
What is the usual dose of bromocriptine?
The usual dose of bromocriptine is 2.5 mg PO 3 times a day.
