••• Chapter 59^ Disorders of Prolactin Secretion^597
❍ What medication is recommended to treat malignant prolactinomas?
Temozolomide therapy.
❍ What is the empty sella syndrome?
A syndrome associated with the incomplete development of the sellar diaphragm that allows the subarachnoid
space into the fossa of the pituitary.
❍ Does the empty sella syndrome progress eventually resulting in pituitary failure?
No.
❍ What is Sheehan syndrome?
Panhypopituitarism following infarction and necrosis of the pituitary secondary to postpartum hemorrhage.
❍ How does the hypothalamus maintain suppression of the pituitary prolactin secretion?
The hypothalamus delivers a prolactin-inhibiting factor through the portal circulation.
❍ How does suckling affect prolactin secretion?
Suckling inhibits the production of prolactin inhibiting factor.
❍ How does dopamine suppress prolactin?
Dopamine binds lactotroph cells and blocks prolactin secretion.
❍ If medication is the cause of galactorrhea, will discontinuation of the medication resolve the galactorrhea?
Yes. Usually within 3 to 6 months.
❍ How is hypothyroidism associated with galactorrhea?
Excess TRH is released and acts as prolactin releasing factor, stimulating prolactin release from the pituitary.
❍ Can excessive estrogen lead to galactorrhea?
Yes. Estrogen can suppress the hypothalamus reducing the production of prolactin inhibiting factor.
❍ Can prolonged suckling stimulate release of prolactin and subsequent galactorrhea from a nonpregnant
patient?
Yes.
❍ Can mild hirsutism occur with ovulatory dysfunction caused by hyperprolactinemia?
Yes.
❍ Can breast implants lead to galactorrhea in women with normal levels of prolactin?
Yes, due to the stimulation of the sensory afferent nerves.