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Medicine

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Endocrine

Question
14 out of 20
 

A 30 year old woman presented with secondary amenorrhea for 3 years along with galactorrhea. The most likely cause of her symptoms would be: (AIIMS May 2013)



A Craniopharyngioma

B Prolactinoma

C Meningioma

D Sub-arachnoid hemorrhage

Ans. B

Prolactinoma

Hyperprolactinemia (Ref. Hari-18th ed. Pg- 2887)

Hyperprolactinemia may result from

1). Excess production from the pituitary, eg prolactinoma. (A prolactinoma is the most common

2). hyperfunctioning pituitary adenoma).

3). Administration of a dopamine antagonist

(Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. It is usually bilateral)

Causes of hyperprolactinemia

1). Physiological: Pregnancy; breast-feeding; stress eg post-seizure.

2). Drugs (most common cause): Phenothiazine; metoclopramide; haloperidol, methyldopa; estrogens.

3). Diseases: Prolactinoma: micro- or macroadenoma;

4). Stalk damage: pituitary adenomas, surgery, trauma; craniopharyngioma,;

5). Other: hypothyroidism, CRF.

Symptoms: Females:

1). Amenorrhea

2). Oligomenorrhea;

3). visual field defect,

4). infertility;

5). Galactorrhea

6). Men have decreased libido and erectile dysfunction and infertility, due to hypogonadism.

7). Hypopituitarism occurs in 50% and it is caused by mass effect of the tumor

Test:

1). Serum prolactin level estimation (It is the most important investigation)

2). If serum prolactin >100 microgram/ml it is strongly suggestive of macroadenoma. Levels more than 200 micro gram per ml occur only in prolactinoma.

3). CT / MRI

Diagnosis is by MRI/CT for confirmation of tumor.

1). Microprolactinomas: A tumour <10mm on MRI

2). Macroprolactinomas: A tumour> 10 mm diameter on MRI.

Treatment:

1). Bromocriptine, a dopamine agonist. PRL secretion, restores menstrual cycles and tumour size.

2). An alternative dopamine agonist is cabergoline: more effective and less side effects.

3). Trans-sphenoidal surgery

4). Radiation therapy for non resectable macroadenomas

Endocrine Flashcard List

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