0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5 5
0
0
0%
0%
Evidence
5 5
0
0
https://upload.medbullets.com/topic/109063/images/bitemp_2.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
  • Symptoms 
    • headache
    • visual changes
      • visual field deficits
      • blurred vision
      • ↓ visual acuity
    • signs of hyperprolactinemia in women
      • amenorrhea or oligomenorrhea
      • infertility
      • loss of libido
      • galactorrhea
    • signs of hyperprolactinemia in men
      • loss of libido
      • impotence
      • erectile dysfunction
  • Physical exam
    • bilateral hemianopsia 
      • mass lesion disrupts visual pathways crossing in the optic chiasm 
    • galactorrhea
    • gynecomastia
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
 

Please rate topic.

Average 4.3 of 6 Ratings

Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.EC.15.75) A 34-year-old woman presents to her OB/GYN with complaints of missing her last 3 periods as well as intermittent spontaneous milky-white nipple discharge bilaterally for the past 3 months. Vital signs are stable and within normal limits. Neurologic examination is without abnormality, including normal visual fields. Serology and MRI of the brain are ordered, with results pending. Which of the following sets of laboratory results would be expected in this patient? Tested Concept

QID: 106775
1

Decreased prolactin, decreased FSH, decreased LH

4%

(3/67)

2

Decreased prolactin, increased FSH, increased LH

1%

(1/67)

3

Increased prolactin, decreased FSH, increased LH

6%

(4/67)

4

Increased prolactin, decreased FSH, decreased LH

76%

(51/67)

5

Increased prolactin, increased FSH, increased LH

10%

(7/67)

M 2 E

Select Answer to see Preferred Response

(M1.EC.13.11) A 45-year-old male presents to the hospital complaining of frequent headaches and a decreased libido. During the physical exam, the patient also states that he has recently been experiencing vision problems. The patient is suffering from what type of adenoma? Tested Concept

QID: 100312
1

Somatotroph

3%

(7/209)

2

Lactotroph

76%

(159/209)

3

Corticotroph

3%

(6/209)

4

Thyrotroph

2%

(4/209)

5

Gonadotroph

15%

(31/209)

M 2 E

Select Answer to see Preferred Response

(M1.EC.13.7) A 29-year-old female visits her gynecologist because of an inability to conceive with her husband. Past medical history reveals that she has been amenorrheic for several months, and she complains of frequent white nipple discharge. Urine tests for beta-HCG are negative. A receptor agonist for which of the following neurotransmitters would be most likely to treat her condition: Tested Concept

QID: 100507
1

Somatostatin

11%

(2/18)

2

Dopamine

89%

(16/18)

3

Vasopressin

0%

(0/18)

4

Insulin

0%

(0/18)

5

Serotonin

0%

(0/18)

M 3 E

Select Answer to see Preferred Response

Evidence (5)
Topic COMMENTS (11)
Private Note