Which level of Prolactin definitely suggest Prolactinoma?
Correct Answer: >200 mg/L
Description: (D) 200mg/LLesions of hypothalamic-pituitary lesion that disrupt hypothalamic dopamine synthesis, portal vessel delivery or lacto-trope responses are associated with Hyperprolactinemia.oHYPERPROLACTINEMIA is the most common pituitary hormone hyper-secretion syndrome in both men & women.oDegree of hyperprolactinemia is usually related to the size of Prolactinoma.oPRL secreting - pituitary adenomas (prolatcinomas) are the most common cause of PRL level >200mg/LoDiagnosis of Prolactinoma is likely with a PRL level >200mg/L oPRL levels <100mg/L may be caused by Microadenomas. oMicroprolactinomas seen with less pronounced PRL elevation & is more commonly caused by drugs, pituitary stalk compression, hypothyroidism or renal failure.oMacroprolactinoma is usually associated with serum PRL levels >250mg/L.oA serum PRL level >500mg/L makes the diagnosis of macroprolactinoma almost certain.oMost common hormone-secreting pituitary tumors, approximately 40% of all pituitary tumorsoMicroprolactinomas more commonoProlactin (PRL) >200mg/mL.oLevels between 20-200 could be due to a prolactinoma or any other sellar massoOccur most frequently in females aged 20-50 years, gender ratio of 10:1oMen: decreased libido, galactorrheaoWomen: amenorrhea, galactorrheaoOccasionally prolactin is co-secreted with GH causing clinical syndrome of both prolactinemia and acromegaly[?]Assessment of HYPERPROLACTINEMIA:oProlactin Values:-Prolactin levels correlates with tumor size:-Normal prolactin levels: 9-25mg/L;50mg/L Functional Hyperprolactinemia-Between 50-100mg/L Microprolactinomas; Over 200mg/L Macroprolactinomas-Bromocriptine test:-2.5 mg bromocriptine must reduce prolactin levels,-Assessment of lesions: CT, MRI-MRI should be performed in all patients with hyperprolactinemia.[?]Hyperprolactinemia:oInvestigation:-Prolactin level - are increased:-Mild increase in Prolactin level 400-600mU/L may be physiological, level above 5000mU/L always imply Prolactin secreting pituitary tumor.-Visual field.-Exclude primary hypothyroidism-Radiology for pituitary tumor. MRI of pituitary (when Prolactin level above 1000mU/L)PROLACTIN PLASMA CONCENTRATIONS*. Normal2.5-17mg/L (Men)1.9-25mg/L (Women)*. HighFrom 30-60 to 150-200mg/LProlactinoma*. Macroprolactinomas (<1 cm in diameter)50-300mg/L(can be as low as 30mg/L)*. Macroprolactinomas (>1 cm in diameter)200-5,000mg/L(can be as high as 35,000mg/L)[?]Pituitary Adenoma:oProlactinoma:-30% of pituitary adenomas-More commonly microdenomas-Present as amenorrhea with galactorrhea-Prolactin levels >200mg/L (if less worry about stalk effect)-First line treatment is pharmacological-Dopamine agonists (bromocriptine)[?]Prolactin:o<25mg/L; Normalo25-150mg/L: Prolactinoma; Stalk effect; Drugs; Hypothyroido>150mg/L: ProlactinomaoHook effect: Even large elevations will show normal PRL levels on testing due to large size of molecules.oDo serial dilution.
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