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Transcript
Internal Medicine
Treatment:
1. Ablative therapy ;
•
Transpheniodal pituitary adenomectomey : results prompt normalization of GH in the
majority of patients
•
Irradiation therapy radiation is generally indicated, but be aware of danger of
hypopituitarism.
2. Medical therapy is indicated if surgery and radiotherapy are contraindicated or have failed.
•
Give bromocriptine up to 15 mg/d PO in divided doses.
Hyperprolactinoma /Galactorrhea
Definition: Hyperprolactinoma is a clinical condition resulting from excess secretion of prolactin
in men, or in women who are not breastfeeding.
Etiology:
1. Prolactin secreting pituitary adenomas (Prolactinoma), are more common in women
than in men, usually appearing during reproductive years. Majority are microadenomas
(< 10 mm in size). Men tend to have larger tumors (macroadenomas), which usually are
suspected because of neurologic impairment and hypogonadism.
2. Damage to the hypothalamus or the pituitary stalk: by tumors , granulomas and
other process may prevent the normal regulatory effect of hypothalamic dopamine on
lactotrope activity , resulting hypersecretion of prolactin.
3. Drugs: drugs that inhibit dopamine activity, and thus interfere with its regulatory activity
on prolactin secretion. Some of the drugs are phenothiazines, antidepressants,
antihypertensives
(methyldopa,
reserpine),
opioids,
cimetidine,
metoclopromide,
contraceptives etc
4. Other rare causes :
•
Primary hypothyroidism
•
Chronic liver disease
•
Renal failure
•
Ectopic prolactin production from tumors (paraneoplastic syndromes)
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