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Updated: Jan 15 2021


Images hemianopsia.jpg
  • Snapshot
    • A 36-year-old woman presents to the physician with complaint of nipple discharge. She states that she has observed a milky discharge coming from both of her nipples for the past 3 weeks. She notes that other abnormal symptoms she has experienced include intermittent headaches and decreased libido. Physical examination reveals a severe visual field defect, depicted in the image.
  • Introduction
    • Overview
      • a prolactinoma is a non-cancerous pituitary tumor that overproduces the hormone prolactin
        • treatment is usually with medication to restore a normal prolactin level or surgical resection
    • Epidemiology
      • incidence
        • most common pituitary adenoma (40% of all pituitary adenomas)
      • demographics
        • more common in women than men
        • peak prevalence in women ages 25-34 years
      • location
        • pituitary gland
          • lateral parts of anterior pituitary are most common sites
    • Pathophysiology
      • prolactinomas arise from monoclonal expansion of pituitary lactotrophs
        • results in excess synthesis and secretion of prolactin
          • ↑ prolactin inhibits GnRH secretion, leading to ↓ LH and FSH secretion
        • can cause hypopituitarism from mass effect
  • Presentation
  • Imaging
    • MRI or CT scan of the pituitary hypothalamic area
      • indications
        • determine if a mass lesion is present
  • Studies
    • Serum prolactin levels
      • measure on 1 or more occassions
    • Serum pregnancy test
      • rule out pregnancy as the cause of secondary amenorrhea in reproductive-aged females
    • Serum TSH
      • rule out the possibility of ↑ prolactin level secondary to an elevated TRH level
    • Serum testosterone levels
      • measure in men presenting with symptoms of hypogonadism
  • Treatment
    • Medical
      • bromocriptine or cabergoline (dopamine agonists)
        • indications
          • first-line treatment
            • dopamine suppresses prolactin secretion
    • Surgical
      • surgical resection
        • indications
          • patients who cannot tolerate or do not wish to take dopamine agonists
          • patients who do not respond to medical treatment or show progression after an initial response to medical treatment
  • Complications
    • Cranial nerve palsies due to mass effect
    • Infertility
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