Hyperprolactinaemia

Question 1

What is the function of prolactin? [1]

Answer 1

it stimulates milk production and lactation

Question 2

Where is prolactin secreted from? [2]

Answer 2

prolactin is secreted by the anterior pituitary / and its release is inhibited by dopamine

Question 3

What is hyperprolactinaemia? [2]

Answer 3

abnormally high levels of prolactin in the blood / >390mU/L

Question 4

What is the effect of raised levels of prolactin? [4]

Answer 4

inhibits secretion of GnRH / so reduced LH/FSH / and so reduced testosterone and oestrogen / so hypogonadism and infertility

Question 5

What is the difference in epidemiology between sexes? [3]

Answer 5

hyperprolactinaemia is more common in and presents earlier in women / as menstrual disturbance / presents later in men as erectile dysfunction

Question 6

What are the 4 causes of hyperprolactinaemia? [12]

Answer 6

1. prolactinoma - tumour of pituitary / leading to excess prolactin production
2. pituitary stalk damage - damage/compression of pituitary stalk / less dopamine so less inhibition
3. drugs - commonest cause / dopamine antagonists
4. physiological - pregnancy / breast feeding

Question 7

What are the symptoms of hyperprolactinaemia? [7]

Answer 7

1. amenorrhoea/oligomenorrhoea
2. infertility
3. galactorrhoea
4. decreased libido
5. erectile dysfunction
6. reduced facial hair
7. local effects of tumour - headaches and visual defects

Question 8

How do you diagnose hyperprolactinaemia? [3]

Answer 8

measure basal prolactin level / which will be very high / but don’t measure in someone on antidopaminergic drugs

Question 9

What is the treatment for hyperprolactinaemia? [2]

Answer 9

medical approach better than surgical approach / dopamine agonists e.g. oral cabergoline