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Hyperprolactinaemia (Aetiology (Neoplastic
Prolactinoma
Pituitary…
Hyperprolactinaemia
Aetiology
Neoplastic
Prolactinoma
Pituitary adenoma (reduce DA inhibition)
Craniopharyngoma (reduce DA inhibition)
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Drugs
Antipsychotics, methyldopa, metaclopramide, ecstasy
(DA inhibitors)
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Diagnosis
Examination
CN exam
Diplopia, ophthalmoplegia,
reduced visual fields, reduced acuity
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Investigations
Bloods
FBC, CRP, U+E, LFT, TFT
Hormones (high PRL)
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Bedside
Obs, measurements, ECG
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History
DH
DA antagonists, other meds, allergies
FH
Cancers, endocrine disorders
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SH
Living arrangements, occupation,
smoking, alcohol, drugs
PC/HPC
ED, reduced libido, amenorrhoea/oligomenorrhoea,
reduced fertility, headaches, galactorrhoea, visual disturbances
Management
Medical
DA agonists
Indication: 1L tx prolactinoma
E.g. bromocriptine, carbergoline
MOA: inc DA, acts as inhibitor
of PRL, reducing PRL levels; reduces tumour size
SEs: nausea, depression, postural HTN
Surgical
Transphenoidal surgery
Indication: intolerant of DA agonists, bulk symptoms
MOA: removal of tumour transphenoidal route
(Via nose)
Conservative
Information, advice, support
Identify and treat cause
Monitoring (PRL levels, visual acuity)
Pathophysiology
Defect
Excess production of PRL or disinhibition of DA from hypothalamus
Hyper-PRL secretion outside of breastfeeding, resulting in galactorrhoea and low FSH/LH (hypogonadism, infertility, etc)
Normal function
PRL needed for lactation during breastfeeding
Inhibits GnRH and FSH/LH (contraceptive)
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