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Year 2 - T2 Theme 1 > L15 Lactation and prolactinomas > Flashcards

L15 Lactation and prolactinomas Flashcards

1
Q

Effect of GH on alveolar buds and lobules during puberty

A

Increase in alveolar buds and lobules via IGF-I

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2
Q

Alveolar development during pregnancy

A
  • Increase in ducts and lobules
  • Differentiated secretory units (acini)
  • Colostrum accumulates
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3
Q

What is colostrum

A
  • Is the first form of milk produced by the mammary glands of mammals (including many humans) immediately following delivery of the newborn
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4
Q

Hormonal changes prior to secretory activation in lactogenesis

A
  • Decrease in progesterone/oestrogen
  • Increase in prolactin (cortisol, insulin)
  • Copious milk production after delivery (usually 2-3 days post-partum)
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5
Q

Sugars in breast milk

A
  • Lactose and oligosaccharides
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6
Q

Fats in breast milk

A

○ triglycerides, cholesterol, phospholipids, steroid hormones

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7
Q

Proteins in breast milk

A

○ Caseins, lactalbumin, lactoferrin, secretory IgA, lysozyme

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8
Q

Minerals in breast milk

A

○ Na, K, Cl, Ca, Mg, Phosphate

- Growth factors

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9
Q

Cellular components of breast milk

A

○ Macrophages, lymphocytes, neutrophils, epithelial cells

○ Phospholipids (membrane fragments)

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10
Q

What is prolactin produced by

A
  • Anterior pituitary
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11
Q

What is oxytocin produced by

A
  • Posterior pituitary
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12
Q

Positive feedback loops - lactation

A
  • Regular removal of milk
  • Nipple stimulation
  • Prolactin (anterior pituitary)
  • Oxytocin (posterior pituitary)
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13
Q

Which cells produce prolactin

A
  • Lactotroph cells located in the anterior pituitary
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14
Q

What are prolactin receptors similar to

A
  • Similarities to GH
  • Similar receptor to GH
  • Tyrosine phosphorylation
  • JAK-STAT signalling
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15
Q

Effects of 5HT, TRH and OXT on the pituitary

A

5HT, TRH and OXT released by hypothalamus have excitatory effects on the pituitary which causes released of prolactin

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16
Q

Effect of dopamine on prolactin release

A
  • Prolactin release is inhibited by dopamine
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17
Q

What is lactational amenorrhoea

A
  • Lactational amenorrhea is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding
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18
Q

What does contraceptive efficacy depend on

A
  • Contraceptie efficacy depends on the frequency and duration of breast feeding
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19
Q

Effect of increase in prolactin on other hormone levels

A

Causes:

  • Decrease in GnRH
  • Decrease in LH and FSH, decrease in pulsatility
  • Decrease in oestrogen/testosterone
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20
Q

Where is oxytocin synthesised

A

Synthesised in hypothalamic magnicellular neurons

  • Supraoptic nucleus
  • Paraventricular nucleus
21
Q

What does the posterior pituitary consist of

A
  • The posterior pituitary is neural tissue and consists only of the distal axons of the hypothalamic magnocellular neurons that make up the neurohypophysis
22
Q

Where are neurosecretory granules released into from the posterior pituitary

A
  • Neurosecretory granules released into capillary system of posterior pituitary
23
Q

Where does the afferent signal from receptors in the nipple ascend to when the infant suckles

A
  • Hypothalamus
24
Q

Effects of oxytocin

A

+ uterine myometrial contraction at birth
+ smooth muscle activation in breast ( ‘myoepithelial contraction’)
+ milk let-down
Potential role in maternal behaviour

25
Q

Evolutionary perspective - mammals lactation

A
  • Reproductive strategy involved producing a nutritious secretion from an exocrine gland and encouraging offspring to consume it
  • Continued nurturing of offspring after birth with benefits including enhanced brain development
26
Q

What does the brain respond to during mating and pregnancy

A
  • Brain responds to hormonal changes associated with ovulation, mating, implantation and pregnancy
  • Via prolactin and placental lactogens
27
Q

Body mechanisms - coping with fetal growth

A
  • Fluid retention
  • Cardiovascular and respiratory changes
  • Altered glucose metabolism
  • Altered immune system
28
Q

How does the body provide support to the fetus

A
  • Uterine growth

- Development of the placenta

29
Q

Behavioural changes in the mother during pregnancy

A
  • Maternal behaviour
  • Adult neurogenesis
  • Reduced anxiety
  • Increased aggression to protect young
30
Q

How does the body cope with increased metabolic demands during pregnancy

A
  • Increased appetite and fat deposition

- Loss of menstrual cycle

31
Q

Hormonal changes during lactation

A
  • Pattern of firing of oxytocin neurons

- Loss of prolactin negative feedback

32
Q

How does hyperprolactinaemia present in women

A
  • Oligo/amenorrhoea –> increase in risk of osteoporosis
  • Galactorrhoea
  • Subfertility
  • May not have all these symptoms
  • May present after stopping contraceptive pill (coincidental)
33
Q

How does hyperprolactinaemia present in men

A
  • Erectile dysfunction
  • Decrease in libido
  • Visual symptoms
  • Headaches
  • Hypopituitarism
  • Present later
  • Galactorrhoea/gynaecomastia(rare)
34
Q

Phsyiological causes of hyperprolactinaemia

A
  • Pregnancy

- Lactation

35
Q

How can hypothalamic-pituitary disease cause hyperprolactinaemia

A
  • Micro/macroPRLoma

- Non-functioning adenoma

36
Q

Other causes of hyperprolactinaemia

A
  • Drugs
  • Stress
  • Polycystic ovarian syndrome
  • Hypothyroidism (increase in TRH)
  • Renal failure, cirrhosis
37
Q

Drugs that increase PRL levels

A
  • Antidepressants and antipsychotics

- Drugs used for nausea and vertigo

38
Q

How do drugs increase PRL levels - mechanisms

A
  • Inhibition of secretion/action of dopamine
  • DA antagonists
  • DA receptor blockers
  • Stimulation of central serotonin (5HT) pathways - 5HT re-uptake inhibitors
39
Q

investigations for hyperprolactinaemia

A
  • Pregnancy test
  • Renal function (U&E, creatinine)
  • Liver function tests
  • Thyroid function
  • Prolactin (repeat)
  • LH, FSH
  • Testosterone (men)
  • MRI pituitary
40
Q

Micro vs macro adenoma

A
  • Micro < 1 cm diameter

- Macro > 1 cm diameter

41
Q

Tests for a macroadenoma

A
  • Visual fields

- Rest of anterior pituitary function tests

42
Q

Aims of treatment - hyperprolactinaemia

A

· Restore fertility
· Stop galactorrhoea
• Also stop nipple stimulation / ‘checking’ (oxytocin)
· Restore regular menstrual periods / libido
• Oestrogen / testosteone needed for bone protection
• Can use exogenous oestrogen / testosterone (contraceptive pill / HRT / testosterone)
· Shrink tumour (macroadenoma)
• Recovery of anterior pituitary function
• Restore vision

43
Q

PRLoma management

A 
· ‘MEDICAL’
· Dopaminergic drugs
	• Cabergoline
	• (Bromocriptine)
· Preserve pituitary function
44
Q

Side effects of PRLoma management

A

• RARE:
○ Fibrotic reactions
□ Pulmonary, pericardial, retroperitoneal
○ Psychiatric disturbances

45
Q

Specific features of microPRLoma treatment

A
  • Can take COCP/HRT if fertility not required
  • Can discontinue treatment in pregnancy
  • May involute post-partum
  • Cn trial withdrawal of treatment after - 2 years (may not recur)
46
Q

What is idiopathic hyperPRLaemia assumed to be

A
  • Assumed to be a microPRLoma too small to be detected radiologically
47
Q

Non-functioning pituitary adenoma (NFA) management

A

• May need surgery & radiotherapy
○ space-occupying effects
○ risk loss of pituitary function
• [prolactin] will ¯ with dopaminergic drugs
○ Need to monitor MRI scan & visual fields

48
Q

What can an NFA cause compression of

A

• Compression of the pituitary stalk
○ ‘Disconnection hyperPRLaemia’
○ May also occur with hypothalamic masses

49
Q

Risk of transphenoidal hypophysectomy

A
  • Risk to vision with further growth

- Potential risk to pituitary growth - including future fertility prospects (though would be amenable to treatment)

Year 2 - T2 Theme 1 (20 decks)

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