Tuesday, March 9, 2010

Prolactinoma

Prolactinoma – Chronic


 


 

Definition  

Benign prolactin-secreting pituitary tumor


 

Findings  

* Amenorrhea - Chronic

* Infertility - Chronic

* Galactorrhea

* Oligomenorrhea

* Impotence

* Reduced libido

* Gynecomastia

* Headache

* Visual field defect

* Cranial nerve disorder

* Ophthalmoplegia

* Seizure

* Hemiparesis

* Depression - Chronic

* Anxiety

* Nausea and vomiting

* Diplopia

* Visual impairment


 

Tests  


 

Suspected prolactin-secreting pituitary adenoma  

* Serum prolactin measurement: Prolactin levels >200 mcg/L suggest a prolactin-secreting pituitary adenoma; levels <200 mcg/L require evaluation of differential diagnoses . Levels of 25 to 40 mcg/L should be repeated .


 

Suspected and known pituitary tumor  

* MRI of pituitary fossa: An image that fails to enhance post-contrast, or a focal hypointense area, seen on MRI suggests an adenoma .


 

Differential Diagnosis  

* Drug-induced hyperprolactinemia

* Physiological hyperprolactinemia

* Disorder of pituitary gland

* Disorder of hypothalamus

* Hypothyroidism - Chronic

* Functionless pituitary adenoma

* Acromegaly

* Chronic renal failure - Chronic

* Adrenal insufficiency

* Cirrhosis of liver

* Idiopathic hyperprolactinemia

* Polycystic ovary syndrome - Chronic

* Lymphocytic hypopituitarism


 

Treatment  


 

Drug Therapy  


 


 

Prolactinoma  


 

BROMOCRIPTINE MESYLATE  

Adults: Initially 1.25 mg to 2.5 mg orally once daily at bedtime, followed by progressive increases over 2 to 3 weeks to 5 to 10 mg/day orally in divided doses ; median dosage is 5 mg/day for microprolactinomas and 7.5 mg/day for macroadenomas (maximum 15 to 20 mg/day)

Pediatrics (?16 years): Initially 1.25 mg to 2.5 mg orally daily, increase dose by 2.5 mg every 2 to 7 days as needed until optimal therapeutic response achieved; usual dose range, 2.5 mg to 15 mg daily

Pediatrics (11 to 15 years): 1.25 mg to 2.5 mg orally daily with gradual dose adjustment to gain therapeutic response; usual dose range, 2.5 mg to 10 mg daily


 

CABERGOLINE (Related toxicological information in CABERGOLINE)  

Adults: 0.5 mg to 1.5 mg orally once or twice/week


 

Non-Procedural Therapy  


 


 

Patients with microprolactinomas with normal menstruation and no galactorrhea  

* Observation
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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

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  2. Osteoarthritis
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Cardiovascular Diseases

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Dermatrologic Diseases

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Endocrine Diseases

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Gynecologic and Obstetric Diseases

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Hematologic Diseases

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i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

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Neurologic Diseases

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Respiratory Diseases

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Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence