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Module 203 Reproduction & endocrinology > T1 L15 Lactation and prolactinomas > Flashcards

T1 L15 Lactation and prolactinomas Flashcards

1
Q

What causes breast development during puberty?

A

Oestrogen
Progesterone
Growth hormone via IGF-1 leads to increased alveolar buds and lobules

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2
Q

What causes breast development during pregnancy?

A

Oestrogen
Progesterone
hCG, prolactin
Alveolar development

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3
Q

What initiates the secretion of milk production?

A

Progesterone

Occurs during pregnancy leading to production of colostrum

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4
Q

What activates the secretion of milk production?

A

Decreased progesterone and oestrogen

Increased prolactin

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5
Q

What is the composition of milk?

A 
Sugar
Milk fats
Proteins
Minerals
Growth factors
Cellular components
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6
Q

What is galactopoiesis?

A

Maintenance of lactation once lactation has been established

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7
Q

Describe lactation amenorrhoea

A

Contraceptive efficacy depends on frequency and duration of breast feeding
Becomes less effective the longer since the birth

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8
Q

Where is prolactin produced?

A

By lactotroph cells in anterior pituitary

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9
Q

What inhibits prolactin release?

A

Dopamine

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10
Q

What stimulates prolactin release?

A

5HT (serotonin)
TRH
Oxytocin

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11
Q

What does increased prolactin lead to?

A

Decreased GnRH
Decreased LH and FSH and decreased pulsatility
Decreased oestrogen / testosterone

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12
Q

Where is oxytocin synthesised?

A

In the hypothalamic magnocellular neurons

  • supraoptic nucleus
  • paraventricular nucleus
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13
Q

Where is oxytocin released from?

A

Posterior pituitary

-distal axon terminals of hypothalamic magnocellular neurons

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14
Q

What are the roles of oxytocin?

A

Cause uterine myometrial contraction at birth
Cause smooth muscle activation in breast (myoepithelial contraction)
Causes milk let down
May have a role in maternal behaviour

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15
Q

How do other mammals know that they’re pregnant?

A

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

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16
Q

Describe how hyperprolactinaemia presents

A

Women:

  • oligomenorrhoea
  • galactorrhoea
  • subfertility

Men

  • erectile dysfunction
  • decrease in libido

Visual symptoms
Headaches
Hypopituitarism

17
Q

What are the general causes of hyperprolactinaemia?

A

Physiological
Hypothalamic - pituitary disease
Drugs
Stress

18
Q

What are some other causes of hyperprolactinaemia?

A

PCOS
Hypothyroidism
Renal failure or cirrhosis

19
Q

What are some physiological causes of hyperprolactinaemia?

A

Pregnancy

Lactation

20
Q

What are some hypothalamic-pituitary cases of hyperprolactinaemia?

A

Micro / macro-prolactinoma

Non-functioning adenoma

21
Q

What drugs can cause hyperprolactinaemia?

A

Antidepressants and antipsychotics

Dopamine antagonists used for nausea and vertigo such as phenothiazines, metoclopramide and domperidones

22
Q

How do drugs cause hyperprolactinaemia?

A

Inhibit secretion / action of dopamine

  • dopamine antagonists
  • dopamine receptor blockers

Stimulation of central serotonin pathways
-5HT re-uptake inhibitors

23
Q

What investigations should be done when suspecting hyperprolactinaemia?

A 
Pregnancy test
Renal function
Liver function tests
Thyroid function
Prolactin
LH and FSH
Testosterone
MRI of pituitary
24
Q

What additional tests could be done when suspecting a macroadenoma?

A

Visual fields

Rest of anterior pituitary function tests

25
Q

What is the management aims for hyperprolactinaemia?

A

Restore fertility
Stop galactorrhea
Restore menstrual periods / libido
Shrink tumour

26
Q

What is the medical management for prolactinomas?

A

Dopaminergic drugs such as cabergoline or bromocriptine

27
Q

What are the side effects of the drugs given for prolactinomas?

A 
Fibrotic reactions
-pulmonary
-pericardial
-retroperitoneal
Psychiatric disturbance
28
Q

Describe the treatment for micro-prolactinomas

A

Can take COCP / HRT if fertility is required
Can discontinue treatment in pregnancy
Can trial withdrawal of treatment after 2 years

29
Q

Describe a non-functioning pituitary adenoma

A

Compression of pituitary stalk

  • disconnection hyper-prolactinaemia
  • may also occur with hypothalamic masses

Module 203 Reproduction & endocrinology (52 decks)

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