Prolactinoma And Acromegaly – Pituitary Disorders For The Step 2 CK exam

by / Monday, 28 June 2010 / Published in Internal Medicine

Pituitary Disorders

Prolactinoma

  • Prolactin-secreting tumor
  • Always think of this when there is visual disturbances

Signs and Symptoms:

Men:

  • Impotence
  • Decreased libido
  • Gynecomastia
  • Most often men also present with headache and visual disturbacnes

Women:

  • Amenorrhea
  • Galactorrhea
  • Both in the absence of pregnancy

Diagnosis:

  • Rule out pregnancy
  • Rule out drugs such as: Metoclopromide, Phenothiazines, and/or TCA
  • MRI to confirm presence of tumor

Treatment:

  • 1st line treatment is a dopamine agonist such as bromocriptine (most prolactinomas respond to DA agonists)
  • If medical therapy doesn’t work, surgical removal is done

Acromegaly

  • Excess production of GH due to a GH-producing adenoma in the pituitary

Signs and Symptoms:

  • Enlargement of the head, hands, feet, nose, and jaw
  • May be enlargement of the sweat that can cause intense sweating
  • Joint abnormalities (excess growth of articular cartilage)
  • Amenorrhea
  • Cardiomegaly and hypertension
  • Colonic polyps
  • Diabetes also common because insulin is antagonized by GH

Diagnosis:

  • Best initial test is IGF (confirms diagnosis of acromegaly)
  • Most accurate test is administration of glucose (normally should suppress GH, if it suppresses GH then this excludes acromegaly)
  • MRI done after there is a reason for doing so

Treatment:

  • Transphenoidal removal
  • DA agonist to inhibit GH release
  • Octreotide has some merit in preventing GH release
  • Pegvisomant à a GH receptor antagonist

6 Responses to “Prolactinoma And Acromegaly – Pituitary Disorders For The Step 2 CK exam”

  1. Friend of mine recommend me to visit your blog, I found the this what I looked for . Thank you very much

    • Dr. Paul Ciurysek, M.D. says : Reply

      Thanks for reading, I’m glad it is able to help you out with whatever you are looking for.

      Paul

  2. Excellent content. Thanks for posting.

  3. dr.sohail mirza says : Reply

    Hi,thanks for a nice posts. Could you please tell me…
    What is the first line of treatment for Acromegaly?
    Transphenoidal surgery or Octreotide? Some books mention surgery as the treatment of choice and some say octreotide is the best medical therapy. In another book I read octreotide is given only while awaiting radiotherapy effects.

    • Dr. Paul Ciurysek, M.D. says : Reply

      Hi Dr. Mirza,

      The latest literature says the first line of treatment is Endoscopic Transnasal, Transphenoidal pituitary microsurgery. If the patient experiences residual symptoms after surgery, the use of a DA-agonist(Cabergoline) or somatostatic analog(Octreotide) is then warranted. Cabergoline therapy should be tried first since it is an oral medication with a good profile.

      Hope that helps,

      Dr. Ciurysek

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