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Labs LH 0.6 FSH 3.5 Prolactin 1,244 Dx : Prolactinoma

63 yo M with cold intolerance, chronic galactorrhea that recently improved, and short term memory difficulties. PMH positive for HTN, anemia, inflamed prostate, gout, heart catheterization. PE WNL. Labs LH 0.6 FSH 3.5 Prolactin 1,244 Dx : Prolactinoma

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Labs LH 0.6 FSH 3.5 Prolactin 1,244 Dx : Prolactinoma

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  1. 63 yo M with cold intolerance, chronic galactorrhea that recently improved, and short term memory difficulties. PMH positive for HTN, anemia, inflamed prostate, gout, heart catheterization. PE WNL

  2. Labs LH 0.6 FSH 3.5 Prolactin 1,244 Dx: Prolactinoma Pt managed with Bromocriptine and MRI follow up every 6 months.

  3. Prolactinomas • Otherwise known as “lactotroph adenomas” • 90% comprised solely of lactotroph cells, 10% also have somatotroph or somatomammotroph cells, which secrete growth hormone • Check for acromegaly • Account for 30-50% of pituitary adenomas • More frequent in women, usually 20-40 yo • Men usually have larger tumors, due to lack of sx or delay in seeking medical attention • Tumors in men may have greater rate of growth

  4. Prolactinomas • Most sporadic, but may occur as part of MEN1 • Most benign, but can be malignant and metastasize • Even microadenomas (<1cm) can cause hyperprolactinemia • Prolactin levels generally correlate to adenoma size • <1cm  <200 ng/mL • 1-2cm  200-1000 ng/mL • > 2 cm  > 1000 ng/ML • Cystic tumors may not follow this rule

  5. Rx • Start Rx when pt is symptomatic (visual impairment, HA, hyperprolactinemiasx that are bothersome) • DA agonists are 1st choice • Decrease prolactin secretion and reduce size of adenoma • Carbegoline (less nausea, may inc risk of valvular heart disease at high doses) • Bromocriptine • Transsphenoidal surgery when DA agonist unsuccessful and for women with >3cm adenoma who wants to become pregnant

  6. Pt’s prolactin has decreased to 200 with treatment. Prolactinoma has shown some mild progression. Will f/u in 6 months.

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