592 Obstetrics and Gynecology Board Review •••
❍ What are the physiologic prolactin concentrations after delivery and in response to suckling?
Basal rate is high comparing with nonpregnant state and may further increase in response to suckling (up to few
hundreds ng/mL). Over 4 to 12 weeks, the prolactin level decreases to normal and there is no longer a rapid release
of prolactin with each suckling episode.
❍ Does breast examination or nipple stimulation increase prolactin secretion in nonlactating women?
No. The magnitude of the increase in prolactin level is directly proportional to the degree of preexisting lactotroph
hyperplasia due to estrogen.
❍ Can prolactin adenomas secrete other hormones?
Yes. Approximately 10% secrete growth hormone as well.
❍ Can other pituitary hormone levels be affected by a mass lesion in the area of sella turcica?
Yes. Thus, levels of all pituitary hormones should be checked in such situation.
❍ Are lactotroph adenomas more frequent with multiple endocrine neoplasia type 1?
Yes. Prolactinomas occur in 20%.
❍ Are lactotroph tumors benign in nature?
In most cases yes, but rare tumors can be malignant and metastasize.
❍ What is the natural history of microadenomas?
Studies with 4 to 6 years of follow-up show that 95% of microadenomas do not enlarge.
❍ True or False: Progression from microadenoma to macroadenoma is rare?
True.
❍ What is the treatment of hyperprolactinemia?
First-line treatment is dopamine agonists as they decrease hyperprolactinemia due to any cause and decrease the
size and secretion of most lactotroph adenomas.
❍ What is the rationale for treatment of hyperprolactinemia?
Existing or impending neurologic symptoms due to the size of lactotroph adenoma.
Endocrine effects of hypogonadism: In women infertility, oligomenorrhea or amenorrhea, hypoestrogenemia
(which may lead to osteoporosis); in men decreased libido and energy, impotence, loss of sexual hair,
osteoporosis, possibly loss of muscle mass.
Galactorrhea may not be sufficiently bothersome to require treatment.
❍ What improvements in symptoms are expected in the majority of patients treated with dopamine agonists?
Resolution of visual field defects.
Resolution of amenorrhea.
Resolution of infertility.
Improvement in sexual function.