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level: Ch3: Prolactinomas

Questions and Answers List

level questions: Ch3: Prolactinomas

QuestionAnswer
What is the treatment of prolactinomas?If medication induced --> stop medication or add dopamine agonist Dopamine agonist shrinks size and decrease PRL (Cabergoline) If Very resistant (RARE) then radiation therapy
What are the clinical features of hyperprolactinemia?Women: Galactorrhea, reproductive dysfunction, menstrual disturbance Men: Hypogonadism symptoms, tumor mass effect, galactorrhea
What is galactorrhea?Nipple secretion, in women if continues after 6 months of delivery considered abnormal and in males it is abnormal Could be unilateral or bilateral, profuse or sparse, can vary in color and thickness
How do we evaluate pt with hyperprolactinemia?All patients with pituitary mass should test their PRL serum level, and all patients with elevated PRL should look for pituitary tumors. Minimal PRL elevation may be an indication to large pituitary tumor not secreting PRL
What are the causes of hyperprolactinemia? physio and pathoPregnancy, lactation, stress, sleep, coitus, exercise (physiologic) Tumors (any kind), granulomas, Infiltrations, rathke's cyst, irradiation, trauma (pathologic)
What are the pituitary origins of hyperPRL?Prolactinoma, acromegaly, macroadenoma compressive, idiopathic, plurihormonal adenoma, lymphocytic hypophysitis, macroPRL
What are systemic disorders causing hyperPRL?Chronic renal failure, PCOS, Cirrhosis, epilepsy, cranial irradiation, pseudocyesis
What are the pharmacological causes of hyperPRL?Dopamine receptor blockers (azines, butyrophenones, metoclopramide) Dopamine synthesis inhibitors (a methyldopa) H2 Antihistamines (climetidine and ranitidine) Estrogens (OCP) Anticonvulsants (phenytoin) Opiates Antidepressants Antipsychotics/ Neuroleptics
What are prolactinomas?Most frequent secretory pituitary tumor, 40/10,000 female to male micro: 20:1, female to male macro: 1:1 75% of all female adenomas, more than 99% are benign. diagnosis by immunostaining PRL, tumor size correlates with PRL level
What is the difference between macro and microprolactinomas?Macro (>10mm, men have larger ones, more invasive and rapid growth in men, concentration more than 200ng/ml) Micro (<10mm, PRL minimal elevation to 100 ng/ml)
How is the pathophysio of hyperprolactinoma?mass pressure on pituitary stalk or portal circulation interrupting inhibitory dopamine
What are the signs and symptoms of prolactinomas?Symptoms of tumor mass (same as ch 3) Symptoms of hyperPRL (menstrual issues, galactorrhea, sexual dysfunction, osteoporosis (due to sex steroid deficiency))
What is the treatment of prolactinomas?If medication induced --> stop medication or add dopamine agonist Dopamine agonist shrinks size and decrease PRL (Cabergoline) If Very resistant (RARE) then radiation therapy