CC March 2016 Prolactinoma

echoecho's version from 2016-06-22 16:40


Question Answer
Define prolactin?1) peptide hormone secreted by the anterior pituitary 2) stimulates female breast during lactataion 3) contributes to surfactant production in the fetal lung 4) inhibits levels of estrogen and testoterone
Where does regulation of prolactin take place? What effect does dopamine have on prolactin?1) involved in the neurons of the hypothalamus (lactotrophs) 2) inhibits prolactin
How does the baby promote milk production?during breastfeeding, mechanical stimulation of the nipple by the baby's mouth leads to a neurally-mediated increase in prolactin, thus promoting milk production
What are the most common type of secretory pituitary tumor?prolactinomas
List the 2 classifications of prolactinomas as to size? 1) microadenoma < 10 mm 2) macroadenoma > 10 mm
Which is type of prolactinoma more common men? in women?macroadenoma; microadenoma
Larger macroadenoma cause what s/s?1) headaches 2) compress the optic chiasm (producing bitemporal hemianopsia) 3) gonadotropin insufficiency by compressing the normal gonadotrophs
Does the serum level of prolactin generally correlate with the size of the prolactinoma?yes
List the clinical manifestations of prolactinomas in women? in men? in both sexes?1) oligomenorrhea; infertility; galactorrhea 2) gynecomastia; impotence 3) decreased libido; headache; visual changes
Obtain what specimen if s/s of hyperprolactonemia are present?first-morning serum prolactin
What 2 things should NOT occur within 30 minutes of the prolactin blood draw?exercise or nipple stimulation
List the normal levels of prolactin in males? in nonpregnant females? in pregnant woman?1) 2-18 ng/mL 2) 2-29 ng/mL 3) 100-209 ng/mL
What other labs studies are indicated?TSH; renal function tests; liver function tests
If hx suggests hypogonadism, what labs should be drawn?estrogen OR testosterone, LH, FSH
What is the imaging test of choice?MRI of the head WITH contrast and focus on the pituitary gland
List the other causes of elevate prolactin level?1) breastfeeding 2) renal failure 3) hepatic failure 4) hypothyroidism 5) chest wall injuries 6) inflammation of the pituitary 7) certain medications
High-dose estrogen may ______ (increase vs. decrease) the prolactin levels?increase
List the partial list of medications associated with elevated serum prolactin levels?1) antidepressants (rare) such as Desipramine (Norpramin), clomipramine (Anafranil) 2) antipsychotics like Risperidone (Risperidal), Olanzapine (Zyprexa), Haloperidol (Haldol) 3) antihypertensives like Verapamil (Calan), Reserpine (Hydromox) 4) Opiates ( codeine, morphine) 5) GI meds like Metoclopramide (Reglan), Cimetidine (Tagamet) 6) Miscellaneous like estrogen (> 30 mcg/day)
Do asymptomatic microadenomas of the pituitary gland require therapy?no
Characteristics of asymptomatic microadenomas?1) they are often incidental findings on MRI done for another reason 2) their rate of growth is very slow and f/u serial imaging is done 2-3 years 3) very unlikely for doubling in size to occur within 3 years
List the indications for treatment in an asymptomatic microadenoma?1) infertility 2) galactorrhea 3) gynecomastia 4) testosterone deficiency 5) amenorrhea 6) hirsuitism
Do macroadenomas (wich are more likely to be symptomatic) require treatment?yes
In men ___% of prolactinomas are macroadenomas largely because of a prolonged asymptomatic phase of growth?80
Macroadenomas present with what s/s?1) neurologic dysfunction 2) headaches 3) visual problems due to mass effect on the chiasm
What is the treatment of prolactinomas?The dopamine agonists = 1) bromocriptine (Parlodel) 2) Cabergoline (Dostinex)
What do these dopamine agonists do?they lower prolactin levels by shrinking the tumor and restoring reproductive function and eliminating galactorrhea
*** Comparing bromocriptine (Parlodel) and Cabergolin (Dostinex), what can be send about the side effect profile and effectiveness in normalizing prolactin levels?Cabergoline (Dostinex) has fewer side effects and is more effective at normalizing prolactin levels
What is the dosing of cabergoline? of bromocriptine?twice weekly; twice daily
List the common side effects of these dopamine agonists?1) orthostatic hypotension 2) GI disturbances (nausea and vomiting)
Prolonged use of cabergoline leads to what?increased risk of valvular heart disease in Parkinson's patients (whose usual dose is > 3 mg/day)
Did a review of 9 studies show an increased cardiac risk in patients treated for prolactinomas in whome the dose is much smaller?no
Both medications are useful for what? facilitating ovulation and pregnancy (however, women usually d/c these medications upon pregnancy confirmation)
Which of the 2 dopamine agonist is the preferred medication for women who wish to conceive?bromocriptine
In women with macroadenomas that are symptomatic and enlarge during pregnnacy, what is the treatment?bromocriptine or cabergoline (appear to be safe and effective options)
Surgical treatment is for what patients?those who fail medical therapy or if there is a contraindincation to dopamine agonists
Tumor recurrence is more common with which prolactinoma (macroadenoma vs. microadenoma)?macroadenoma
Do beta-blockers have any role in treating prolactinomas?no
*** SUMMARY = What are the most common types of secretory pituitary tumor?prolactinomas
*** SUMMARY = Which prolactinoma is common in women? in men?microadenoma; macroadenoma
*** SUMMARY = What serum level of prolactin generally correlates with the ____ of the prolactinoma?size
*** SUMMARY = Obtaining a _______ serum prolactin level is indicated if symptoms of hyperprolactinemia are present?first-morning
*** SUMMARY = What 2 dopamine-agonists are the primary medical therapies used to treat symptomatic prolactinomas?1) bromocriptine (Parlodel) 2) cabergoline (Dostinex)