Endo: Prolactinoma: Free MSRA Podcast

🎧 FREE MSRA PODCAST – Prolactinoma: Hormone Havoc, Headaches & Hidden CluesIn this high-impact episode, we demystify Prolactinoma, the most common hormone-secreting pituitary tumour. Learn how to recognise the telltale symptoms, distinguish it from other causes of hyperprolactinaemia, and memorise the key treatment steps. Perfect for fast MSRA recall.🧠 Key Learning Points📌 Definition• Prolactinoma = benign pituitary adenoma that secretes excess prolactin• Causes hyperprolactinaemia → disrupts sex hormones (↓ oestrogen/testosterone)📌 Causes• Usually idiopathic monoclonal tumour growth• May be linked to MEN1 (genetic syndrome)• Other causes of raised prolactin to exclude: – Pregnancy, breastfeeding – Stress, exercise, sleep – Medications: metoclopramide, domperidone, antipsychotics (e.g. haloperidol) – Hypothyroidism (↑ TRH stimulates prolactin) – Pituitary stalk compression = "stalk effect"📌 Pathophysiology• Excess prolactin → ↓ GnRH → ↓ LH & FSH → hypogonadism• Leads to infertility, sexual dysfunction, and menstrual irregularities• Large tumours (macroadenomas >1cm) may compress optic chiasm → visual field loss📌 Symptoms👩 Women:• Amenorrhoea, galactorrhoea, infertility• Vaginal dryness, low libido, osteoporosis if prolonged👨 Men:• Erectile dysfunction, low libido• Less commonly, galactorrhoea or gynecomastia🧠 Both sexes (if macroadenoma):• Headaches• Bitemporal hemianopia• Features of hypopituitarism (if compression)📌 Diagnosis• Serum prolactin: high• Rule out other causes (e.g. TSH for hypothyroidism, drug history)• Pituitary MRI: confirms size and location• Mild elevation? Consider stalk effect vs true adenoma• Visual field testing for macroadenomas📌 Management (UK)1️⃣ Dopamine agonists = first-line – Cabergoline (preferred): weekly dosing, better tolerance – Bromocriptine (used in pregnancy)2️⃣ Monitor prolactin + tumour size (MRI)3️⃣ Surgery (transsphenoidal) if: – Poor response to meds – Intolerable side effects – Compressive symptoms (e.g. vision loss)4️⃣ Rarely, radiotherapy if surgery fails or recurrence💊 Pregnancy:• Microadenoma: usually safe, stop dopamine agonists• Macroadenoma: close monitoring ± continuation of bromocriptine if needed• Warn patients about headaches/visual changes during pregnancy📌 Prognosis & Complications• Excellent prognosis with dopamine agonists• Long-term management often needed• Complications (if unmanaged): – Infertility, osteoporosis, hypopituitarism – Visual field defects – Very rarely, tumour apoplexy or aggressive growth📎 More MSRA Resources for Prolactinoma📝 Revision Notes:https://www.passthemsra.com/topic/prolactinoma-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/prolactinoma-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/prolactinoma-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/prolactinoma-rapid-quiz/🎓 Full Endocrinology Course:https://www.passthemsra.com/courses/endocrinology-for-the-msra/#MSRA #MSRARevision #ProlactinomaMSRA #EndocrinologyMSRA #PituitaryTumour #MSRAFlashcards #MSRAQuiz #Hyperprolactinaemia #PassTheMSRA #MSRAOnlineRevision