Hyperprolactinaemia Flashcards
What is Hyperprolactinaemia?
Condition of high Prolactin in blood
Does Hyperprolactinaemia present early / late in men / women?
- Early in women (menstrual disturbances)
- Late in men (erectile dysf)
What are the causes of Hyperprolactinaemia? (3 things)
- Excess prod by pituitary (e.g PROLACTINOMA)
- Disinhibition by pituitary stalk compression –> reducing dopamine levels (dopamine inhibits prolactin secretion)
- Using a dopamine antagonist (reducing dopamine levels)
What are the pathophysiological steps of Hyperprolactinaemia? (4 things)
- High levels of Prolactin
- Inhibits Gonadotropin Releasing Hormone (GnRH) secretion
- Low FSH / LH / Oestrogen / Testosterone
- Hypogonadism / Infertility / Osteoporosis
What drugs are Dopamine antagonists (and hence cause Hyperprolactinaemia)? (5 things)
- Metoclopramide (anti-emetic)
- Haloperidol (anti-psychotic)
- Methyldopa (anti-HTN)
- Oestrogens
- MDMA / ecstasy
What is a reason for non-compliance of anti-psychotics (e.g haloperidol) in relation with Hyperprolactinaemia? (3 steps)
- Anti-psychotics = dopamine antagonists
- Cause Hyperprolactinaemia
- This causes: Reduced libido / Anorgasmia / Erectile dysf
What are the CF of Hyperprolactinaemia in WOMEN? (6 things)
- Reduced libido
- Galactorrhoea
- Dry vagina
- Amenorrhoea / oligomenorrhoea
- Infertility
- Weight gain
What are the CF of Hyperprolactinaemia in MEN? (4 things)
- Reduced facial hair
- Galactorrhoea
- Erectile dysf
- Osteoporosis (late)
What investigations should you do for sus Hyperprolactinaemia? (5 things)
- Basal test for Prolactin levels (venepunctre between 9am - 4pm)
- Pregancy test
- Thyroid function test
- UnEs
- MRI pituitary (if all other causes defo ruled out)
Why should you do Thyroid function test (alongside Basal Prolactin levels test) for someone with sus Hyperprolactinaemia (aka amenorrhoea)?
Pt w ABN TSH levels + NORMAL Prolactin = Thyroid disease
To rule out Thyroid disease bc present similarly (amenorrhoea)
Why should you do a pregnancy test for sus Hyperprolactinaemia?
Could just be skipping periods because pregnant
What are the management options for Hyperprolactinaemia? (2 things)
- Dopamine agonists (e.g Bromocriptine / Cabergoline) (FIRST LINE)
- Treat underlying cause:
- Surgery for Prolactinoma tumour (trans-sphenoidal)
- Discontinue Dopamine antagonists
Bromance or Cabbage to crip the milk lol
What do Dopamine agonists do in Hyperprolactinaemia? (3 things)
- Reduce Prolactin secretion
- Restore menstrual cycles
- Reduce tumour size
What should be done for a pt treated for Hyperprolactinaemia? (2 things)
- Can decrease medication after 2 years
- BUT regular follow up bc Hyperprolactinaemia recurrence / tumour expansion
- MRI + check visual fields (if headache + visual loss)
