Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1222 Prolactinoma and Galactorrhea Prostate Cancer

■Measure serum prolactin after 4–6 wks of therapy

■Repeat pituitary MRI in 3–6 mo to assess pituitary growth/shrinkage

complications and prognosis

■Pituitary apoplexy (in patients with macroadenomas):

➣Very severe headache, altered consciousness, coma

➣Requires emergent surgical intervention and resection of tumor

■Visual field changes:

➣Signifies tumor growth

➣May occur in pregnancy with macroprolactinomas

➣Requires institution of dopaminergic agents or surgery

■Pregnancy

■Macroadenoma: requires lifelong therapy

■Microadenoma: may stop therapy at menopause

PROSTATE CANCER

JOHN D. McCONNELL, MD

REVISED BY BIFF F. PALMER MD

history & physical

History

■Aging: Overall lifetime risk approximately 1 in 12; occult, clinically

insignificant prostate cancer present in half of men over age 70

■Race: risk two-fold higher in African American, with a tendency to

occur in younger men

■Family history: a brother or father with prostate cancer increases an

individual’s risk by two-fold

Signs & Symptoms

■Local, organ-confined cancer is usually asymptomatic.

■Locally and locally advanced disease:

➣Lower urinary tract symptoms (frequency, urgency, decreased

force of stream, incomplete bladder emptying, nocturia)

➣Hematuria (especially with invasion of the bladder)

➣Hematospermia (blood in the semen, usually a benign symptom)

➣Rarely symptoms of renal failure from ureteral obstruction (nau-

sea, vomiting, lethargy)

■Advanced, metastatic disease:

➣Bone pain (lumbar vertebrae, pelvis, femur, most common)

➣Weight loss, anorexia