Hyperprolactinemia

Question 1

Definition of prolactinemia and prolactinoma

Answer 1

High serum prolactin (from lactotrophs)
Most common in females
Benign adenoma or pituitary gland producing excess prolactin

Question 2

Causes of hyperprolactinemia?

Answer 2

Prolactinoma
Drugs-anti dopaminergic drugs (eg. Ecstasy) - most common

Question 3

Pathology of prolactinoma
Whats are the 2 types?

Answer 3

Micro (<10mm diameter in MRI - most common 90%)
Macro (>10 mm diameter in MRI)

Non functional pituitary tumour - compresses pituitary stalk - no inhibition of prolactin release - increased release = galactorrhoea by stimulating milk production from mammary gland, inhibiting FSH and LH

Question 4

Signs and symptoms

Answer 4

Visual defect (bitemporal hemianopia)
Amenorrhea
Sexual dysfunction (M+F) - infertility
Decreased libido
Decreased testosterone

Question 5

Diagnosis

Answer 5

Increased serum prolactin
(CT head)

Question 6

Treatment

Answer 6

1st line = dopamine agonists eg. Cabergoline, bromocriptive (massively shrinks tumour as DA inhibits prolactin)

Gold standard = transsphenoidal resection surgery