Acromegaly and Prolactinoma - SRS Flashcards Preview

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Flashcards in Acromegaly and Prolactinoma - SRS Deck (31):

Why would a female with acromegaly have abnormal menstrual cycles?

!!TQ here!!

Acromegaly may be accompanied by amenorrhea and galactorrhea because...

  1. GH stimulation of the prolactin receptor (both are cytokine receptors)
  2. GH may cosecrete prolactin (mammosomatotroph adenoma)
  3. Tumor may press on the pituitary stalk and block transit of dopamine
  4. Impaired gonadotropin secretion by the pituitary (d/t increased prolactin suppression)




What are the causes of a positive Tinel's sign?

Which one would apply in this class?

Mnenonic is "Median Trap"

  • Myxedema
  • Edema
  • Diabetes
  • Infiltration
  • Amyloid
  • Neoplasms


  • Trauma
  • Acromegaly
  • Pregnancy


What type of headache is worse with coughing, associated with nausea and worse on arising?

Those caused by a brain tumor



Why the acanthosis nigricans and skin tags in patients with acromegaly?

D/t insulin resistance and excess IGF-1


When testing for acromegaly we do what challenge?

What would a positive result be?

What would you do next?

75g glucose challenge, check glucose and GH levels every 30 minutes post administration - positive if this fails to suppress GH to less than 1 ng/mL.

THEN, if positive order an MRI.



What are the causes of acromegaly?


  1. Microadenoma with somatotroph mutation
  2. Macroadenoma
  3. Ectopic GH or GHRH production


What are some examples of cancers that cause ectopic production of GH or GHRH?


  1. Carcinoid
  2. Pancreas
  3. Lung
  4. Ovary
  5. Breast
  6. Lymphoma


Acromegaly and giantism may be associated with what syndromes?

1. MEN 1 ( 3 Ps with hypercalcemia, peptic ulcer, or hypoglycemia).

2. Carney complex  ( mutation in tumor suppressor gene for protein kinase A).

3. MuCune-Albright syndrome (Polyostotic fibrous dysplasia, café au lait, endocrine hyperfunction).


What does this child who is at risk of gigantism have?

Q image thumb

McCune Albright Syndrome - Polyostotic fibrous dysplasia, café au lait, endocrine hyperfunction


What are 3 associated complication types of a GH secreting adenoma?

1.Pressure effects (headache, visual alterations, etc).

2.Additional hormone production (cosecretion of prolactin).

3.Interference with other hormones (decreased ACTH, TSH, etc).


List for me 8 comorbidities associated with Acromegaly.

  1. Sleep apnea
  2. Hypertension
  3. Diabetes
  4. Cardiomyopathy 
  5. Colon polyps
  6. Degenerative joint disease 
  7. Thyroid nodules
  8. Premature mortality


Based on the comorbidities associated with a GH adenoma, what are three tests you should consider doing?

List why for each.

ECHO - test for cardiomyopathy

Colonoscopy - Colon Polyps common

Vertebral Xray - degenerative joint disease seen here




What are some options for pharm tx of GH adenomas?

7 options, 6 of which are on our drug list

  1. Bromocriptine - DA agonist
  2. Cabergoline - DA agonist
  3. Octreotide - SST analogue
  4. Lanreotide - SST analogue
  5. Pasireotide - SST analogue
  6. Pegvisomat - GH receptor antagonist




Apart from the pharm tx, what other options are there to deal with an adenoma?

  1. Surgery
  2. Radiation


If you send a pt to undergo transphenoidal surgery for removal of a GH adenoma, and they only find hyperplasia, what should you do?

Look for an ectopic source of either GH or GHRH


Which of the lung cancers is most likely to secrete GHRH?

Small cell (AKA Oat cell)


What should be done prior to surgery for a GH producing adenoma?

GHRH assay to look for possible ectopic production



How should you follow a patients progress after tx of an adenoma?

Monitor GH and IGF-1.

If suspicous of a recurrence, do a Glucose challenge test.


What are the goals of therapy in a GH secreting adenoma?

Reduced IGF-1

Glucose suppression of GH to under 1 ng/mL



Why would a female patient with a prolactinoma have dyspareumia, hirsutism and acne?

!! TQ here !!

Decreased estrogen leads to decreased sex hormone binding globulin (SHBG) and this leads to increased free testosterone and DHEAS.  This leads to the hirsutism, acne and dyspareunia.



Causes of hyperprolactinemia can be grouped into:

  1. Endocrine
  2. Drugs
  3. Other

What are the Endocrine causes? 4

  1. Pituitary adenoma
  2. Hypothalamic disease
  3. hypothyroidism
  4. pregnancy


Causes of hyperprolactinemia can be grouped into:

  1. Endocrine
  2. Drugs
  3. Other

What are the Drug causes?  7 with three bolds

  1. Metoclopramide
  2. SSRI
  3. opiates
  4. Verapamil (and other anti-HTN)
  5. Estrogen
  6. Cimetadine
  7. Protease inhibitors


Causes of hyperprolactinemia can be grouped into:

  1. Endocrine
  2. Drugs
  3. Other

What are the "Other" causes? 

  1. Cirrhosis
  2. Exercise
  3. macroprolactinemia (IgG binding)
  4. Nipple stimulation
  5. REM sleep
  6. Renal Failure
  7. SLE
  8. Stress


Darrow gave us a mnemonic for the causes of hyperprolactinemia.  What was it?


Hypertensive meds (verapamil, reserpine, alpha methyldopa)

Infiltrative disease (sarcoid, hemochromatosis, etc); Infection (TB, Histo, etc)

Growth hormone (acromegaly)

Hypothyroidism(TRH) ; H2 blockers(cimetidine, ranitidine)

Pregnant/Postpartum; PIs; macroProlactinemia

Renal failure; Reglan (metoclopramide and dopamine inhibitors)

Oral contraceptives (estrogen); Opiates

Liver diseases (cirrhosis)

Adenoma of pituitary; empty sella


Tranquilizers (including risperidone); Tricyclics and SSRIs; Trauma; Tumor

Idiopathic (look for macroprolactinemia – 10% of hyperprolactinemic patients)

Nipple and chest wall stimulation (zoster)

Stress; Sleep; Seizures; Surgery; SSRIs; SLE; multiple Sclerosis; Sexercise


What level of prolactin would be found with a prolactinoma?

Generally over 200 ng/mL

If 20 - 100, would indicate a different cause.


What would you expect to see in a male with prolactinoma?

1. Loss of libido

2. Impotence

3. Bitemporal hemianopsia


What do you suspect if a patient with a high level (>200 ng/mL) of prolactin and a negative MRI has no symptoms?

Macroprolactinemia - large prolactin molecule


If you find a macroadenoma on MRI what should you do?

Screen for other pituitary insufficiencies



What are the treatment options for hyperprolactinemia?

  1. Bromocriptine
  2. Cabergoline
  3. Surgery
  4. Radiation



What is postpartum cardiomyopathy related to?

Abnormal prolactin molecules