Lactation, galactorrhoea, prolactinoma Flashcards Preview

203: The endocrine system > Lactation, galactorrhoea, prolactinoma > Flashcards

Flashcards in Lactation, galactorrhoea, prolactinoma Deck (18)
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1

Prolactin levels during pregnancy and breastfeeding

Rises during pregnancy
- Stimulates duct and lobule development in breast
- Develops acini [secretory units]

2

Lactational amenorrhoea

Lack of menstrual periods during breastfeeding
- High prolactin levels dampens the gonadal axis.
- Inhibits GnRH, LH, FSH, oestrogen/progesterone

3

Oxytocin and lactation

Stimulates milk let down
- Contraction of smooth muscle in the breast [myoepitheium]

Positive feedback
- Stimulation of the nipples/ pavlovian reflex

4

Benefits of mammals lactating

Production of nutritious secretion
- Helps development both in brain and body

Hormones released helps to develop the 'maternal' aspect of the mother's brain.
- Metabolic and psycho-social behavioural

5

Hyperprolacteraemia
- Presentation in women

Amenorrhoea/ oligomenorrhoea

Galactorrhea

Sub-fertility
- Increases osteoporosis risk

Can present after contraceptive pill but is coincidental

6

Hyperprolacteraemia
- Presentation in men

Presents later due to the non-specific symptoms

Erectile dysfunction [prolactin dampening gonadal axis]
Decrease in libido

Larger adenomas
- Visual defects
- Hypopituitary
- Headaches

Rarer
- Gynecomastia
- Galactorrhea

7

Causes of hyperprolacteraemia

Physiological
- Pregnancy
- Lactation

Hypothalamico-pituitary
- Prolactinomas
- Non-functioning adenoma

Drugs

Stress [increases when stressed, like cortisol]

Poly cystic ovarian syndrome

Renal failure

Cirrhosis

8

Drugs that increase prolactinoma

Antidepressants

Antipsychotics

Drugs for nausea and vertigo
- Phenothiazine
- Domperidone
- Metoclopramide

9

Investigations into prolactinoma

Pregnancy tests

Renal function

Liver function tests

Repeating prolactin test [incase it was stress]

LH. FSH

Testosterone in males

MRI pituitary

Visual tests and anterior pituitary function [macroadenoma]

10

Aims of treating prolactinoma

Restore fertility

Stop galactorrhoea
- Stocking nipple stimulation/ checking oxytocin

Restore menstrual periods/ libido [and bone strength]
- Hormone treatment [oestrogen/ testosterone]

Shrinking macroadenoma

11

Drugs to treat macroprolactinoma
- Include side effect

Dopaminergic drugs
- Cabergoline

Shrinks macroadenoma and preserves pituitary function

Rare
- Fibrotic reaction [pulmonary, pericardial, retoperitoneal]
- Psychiatric disturbance.

12

Drugs to treat microprolactinoma

Hormonal therapy if fertility is not required
- Then discontinue during pregnancy and give cabergoline

13

Non functioning pituitary adenoma treatment

If compressing pituitary stalk
- Surgery and radiotherapy

Pituitary still monitored with MRI and visual field assessment
- Dopaminergic drugs will decrease prolactin

14

Breast development
- Puberty
- Pregnancy
- Breastfeeding

Puberty
- Increase in oestrogen, progesterone, GH
- Alveolar buds and lobules increased

Pregnancy
- Oestrogen, progesterone increases
- As well as hCG and prolactin
- Increases alveolar development--> colostrum accumulate

Breastfeeding
- Copious milk production

15

Milk composition

Sugar

Milk fats

Proteins

Minerals

Growth factors

Cellular components
- Immune cells
- Phospholipids

16

Prolactin secretion regulation

Stimulation
- Serotonin
- TRH
- Oxytocin

Inhibition
- Dopamine

17

Effects of prolactin of the gonadal axis

Depresses GnRH
- Decreases its pulsatility
- Depresses LH, FSH
- Depresses oestrogen and testosterone levels

18

How to treat idiopathic hyperprolactinaemia

Assumed to be microprolactinoma
- Too small to be detected
- Treated with dopaminergic drugs