Approach to Prolactinemia

Question 1

Hypothalamic dopamine __ prolactin synthesis & secretion

Answer 1

Hypothalamic dopamine inhibits prolactin synthesis & secretion

Question 2

how does prolactin affect breast tissue

Answer 2

This is what prolactin does to the breast: stimulates milk production from a developed breast

Question 3

why does the pituitary increase in size during pregnancy/

Answer 3

estrogen acts as a lactotroph. direct action on the lactotroph to increase secretion and produce celllar hyperplastia

Question 4

how does nursing affect prolactin levels?

Answer 4

it sustains it

Question 5

causes of high prolactin

Answer 5

HIPROLACTIN

H:hypothalamic disease (sarcoid, granulomatous)

I: infiltrative (hypo, stalk, pituitary level because of sarcoid, MM, hemochromatosis)

P; pregnancy, prolactinoma, PCOS

R; renal failure

O: oral intake

L: liver disease

A: AHHHH idk (idiopathic)
C: Chest wall disorder like shingles

T: thyroidism, hypothyroidism

I: ingested meds

N: nipple stimulation

Question 6

symptoms of high prolactin (often in women)

Answer 6

1. galactorhhea
2. hypogonadism (loss of testosterone in men)
3. amenorrhea (hypogonadism in women)

Question 7

why does high prolactin cause hypogonadism?

Answer 7

prolactin inhibits GnRH secretion, which usually stimulates LH/FSH release and thus estrogen and testosterone. This is blocked.

Question 8

T/f hyperprolactin causes early onset puberty

Answer 8

false. PRl effects negatively on GnRH, causing a pubertal delay.

Question 9

note: Causes of pathological hyperprolactinemia at different levels

Question 10

diagnostic evaluation of hyperprolactinemia

Answer 10

1. clinical presentation
2. serum prolactin– if normal, repeat and follow
3. history and physical exam– if a cause is found, stop the cause
4. Hcg: pregancy causes icnrease in prolactin
5. TSH– hypothyroidism causes incease in prolactin. GIve thyroxine.
6. MRI

Question 11

why is surgery beter for smaller tumors?

Answer 11

• studies show that surgical resection of a microadenoma resolves high prolactin in over 71% cases, where as macros only have a 30% success rate

Question 12

ergot fungus ___ lactation

Answer 12

inhibits lactaion by reducing prolactin

Question 13

medication stemmed from ergot fungus as a treatment for hyperprolactin

Answer 13

bromocriptine is a D1 and D2 agonist that reduces prolactin secetion, and has been found to shrink prolactinomas. It’s sister drug, cabergoline, is now used as it is superior

Question 14

Not all people with hyperprolactinemia have galactorrhea
Not all people with galactorrhea
have hyperprolactinemia.

How can you tell if breast dischage is galactorhhea?

Answer 14

if it was true breast milk, you would see fat colloids.

Question 15

T/F the most common cause of calactorrhea is due to hyperprolactinemia

Answer 15

false. Most common cause of galactorrhea – idiopathic