Tag: Prolactinomas

Prolactinomas

Prolactinomas

Q. 1

Which of the following pairs are correctly matched:
1. Endometriosis – Danazol
2. Endometrial carcinoma – Oestrogen
3. Anovulatory infertility – Clomiphene
4. Prolactinoma – Bromocriptine
Select the correct answer using the codes given below:
 A

1, 2, 3 and 4

 B

1, 3 and 4

 C

2, 3 and 4

 D

1 and 2

Q. 1

Which of the following pairs are correctly matched:
1. Endometriosis – Danazol
2. Endometrial carcinoma – Oestrogen
3. Anovulatory infertility – Clomiphene
4. Prolactinoma – Bromocriptine
Select the correct answer using the codes given below:
 A

1, 2, 3 and 4

 B

1, 3 and 4

 C

2, 3 and 4

 D

1 and 2

Ans. B

Explanation:

The use of estrogen replacement therapy in women who have been treated for endometrial cancer is controversial.
Risk factors for endometrial carcinoma include unopposed estrogen, obesity, nulliparity, chronic anovulation, late menopause, hypertension, diabetes, hyperplasia with atypia, Lynch II syndrome, and prolonged use of tamoxifen.
 
Danazol acts via several mechanisms to treat endometriosis. 
 
Clomiphene citrate (CC) is the initial treatment for most anovulatory infertile women.
 
The ergot alkaloid bromocriptine mesylate is a dopamine receptor agonist that suppresses prolactin secretion in prolactinoma.
 
Ref: Suh G.K., Hennessy B.T., Markman M. (2011). Chapter 29. Tumors of the Uterine Corpus. In H.M. Kantarjian, R.A. Wolff, C.A. Koller (Eds), The MD Anderson Manual of Medical Oncology, 2e.

Q. 2

Regarding prolactinoma in pregnancy, all are true, EXCEPT:

 A

Most common pituitary tumor but rarely symptomatic

 B

Increase in prolactin levels worse prognosis

 C

Macroadenoma > 1 cm is associated with bad prognosis

 D

Regular visual checkup

Q. 2

Regarding prolactinoma in pregnancy, all are true, EXCEPT:

 A

Most common pituitary tumor but rarely symptomatic

 B

Increase in prolactin levels worse prognosis

 C

Macroadenoma > 1 cm is associated with bad prognosis

 D

Regular visual checkup

Ans. C

Explanation:

Pituitary adenoma more than 2cm is associated with bad prognosis. Other poor prognostic factors includes high preoperative prolactin levels, increased age and longer duration of amenorrhea. Prolactinomas are prolactin secreting tumours of the pituitary It is a benign tumour It is the commonest pituitary tumor seen in pregnancy. During pregnancy the stimulatory effect of hormonal mileu of pregnancy result in significant enlargement of prolactinoma during pregnancy. Patients with prolactinoma usually presents with amenorrhea, galactorrhea, headache, visual field defect (bitemporal hemianopia) and diabetes insipidus

Quiz In Between



Prolactinomas

Prolactinomas


PROLACTINOMAS

  • Most common functioning tumour is prolactinomas.
  • Microadenomas- < 1cm in diameter (do not invade parasellar region)
  • Macroadenomas- > 1cm in diameter (locally invade on adjacent structure)

 Clinical features- 

  • Macroprolactinomas- 20: 1 (F : M)
  • Macroadenomas-  1:1
  • Values of PRL concentration >250 μg/L are associated with macroadenomas.
  • Men present with loss of libido, infertility, signs of CNS compression, visual defects.
  • Females with amenorrhea, infertility and galactorrhea.

Investigations-

  1. MRI of ahead
  2. Serum prolactin levels
  • PRL < 100 μg/ L- microadenomas
  • PRL >200 μg/ L- prolactinoma

Treatment- 

  1. Asymptomatic microadenoma- no treatment required
  2. Oral dopamine agonists (calcium bergoline and bromocriptine) are the line of treatment with micro or macroprolactinomas.
  3. In pregnancy, bromocriptine taken

Surgery-

  • Dopamine resistance
  • Invasive macroadenomas

Exam Important

Clinical features- 

  • Values of PRL concentration >250 μg/L are associated with macroadenomas.
  • Men present with loss of libido, infertility, signs of CNS compression, visual defects.
  • Females with amenorrhea, infertility and galactorrhea.

Investigations-

  1. MRI of ahead
  2. Serum prolactin levels
  • PRL < 100 μg/ L- microadenomas
  • PRL >200 μg/ L- prolactinoma
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