USMLE/COMLEX - Step 2 - Hyperprolactinemia

USMLE/COMLEX - Step 2 - Hyperprolactinemia Hyperprolactinemia is characterized by high levels of prolactin hormone in the blood, which can be divided into primary and secondary categories. Primary hyperprolactinemia is due to intrinsic pituitary glands disorders, such as prolactinoma, other pituitary tumors, or idiopathic causes. Extrinsic factors like medications and medical conditions such as hypothyroidism, liver disease, or pregnancy cause secondary hyperprolactinemia. The condition's pathophysiology is related to alterations in the regulation of prolactin secretion. Irregular menstrual periods or absent menstrual periods Infertility or decreased libido Breast milk production in women who are not pregnant or nursing Breast tenderness or enlargement Erectile dysfunction and decreased libido in men Headaches Vision changes Galactorrhea Amenorrhea Gynecomastia Infertility Oligomenorrhea Hypogonadism Decreased bone density Blood tests measuring prolactin levels MRI CT scan Visual field testing Thyroid function tests Pregnancy test The treatment of hyperprolactinemia depends on the underlying cause, the severity of symptoms, and the patient's overall health. Here are some treatment options for hyperprolactinemia: 1. Medications: Dopamine agonist medications, such as bromocriptine and cabergoline, are often the first-line treatment for hyperprolactinemia caused by a pituitary tumor. These drugs work by reducing the production of prolactin by the pituitary gland. 2. Surgery: Surgical removal of a prolactinoma may be necessary if medication therapy is not effective, the tumor is large or causing significant symptoms, or if there is suspicion of a malignant tumor. 3. Radiation therapy: Radiation therapy may be used in rare cases where medical or surgical treatment is not feasible or the patient is not responding to medication therapy. 4. Treating underlying conditions: In cases where hyperprolactinemia is caused by an underlying medical condition, such as hypothyroidism, treating the underlying condition can help normalize prolactin levels. 5. Monitoring: Regular prolactin levels and imaging studies may be necessary to assess the effectiveness of treatment and monitor for any recurrence or progression of a pituitary tumor.