Prolactinoma differential diagnosis: Difference between revisions

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Revision as of 18:19, 20 July 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Prolactinoma must be differentiated from other causes of hyperprolactinemia.

Causes of hyperprolactinemia can be categorized as physiological, pathological and medication-induced.

Differential Diagnosis

Prolactinoma must be differentiated from other causes of hyperprolactinemia including:

Physiological:
- Normal pregnancy^[1]
Pathological:Pituitary tumors (other than prolactinoma):^[2]
- Somatotroph adenoma: Acromegaly
- Corticotroph adenoma: Cushing's syndrome

- Supra seller tumors(tumors present in region of pituitary stalk)
- Hypothyroidism^[3]
- Chronic renal failure^[4]
- Liver disease^[5]
  - Cirrhosis(with or without encephalopathy)
  - Viral hepatitis(with encephalopathy)
- Seizure disorder^[6]
Medication-induced:
- Antipsychotic medications:^[7]
  - Haloperidol
  - Risperidone
- Antiemetic medications:
  - Metoclopramide^[8]
  - Domperidone^[9]
- Antihypertensive medications:
  - Methyldopa^[10]
  - Verapamil^[11]

Disease	Clinical Findings	Laboratory findings	Management
Somatotroph adenoma: Acromegaly	Clinical features of acromegaly are due to high level of human growth hormone(hGH): Soft tissue swelling of the hands and feet Brow and lower jaw protrusion Enlarging hands Enlarging feet Arthritis and carpal tunnel syndrome Increase in teeth spacing Macroglossia [enlarged tongue] Heart failure Kidney failure Compression of the optic chiasm leading to loss of vision in the outer visual fields (typically bitemporal hemianopia) Headache Diabetes mellitus Hypertension Cardiomegaly	Elevated insulin-like growth factor-1 (IGF-1) levels Elevated growth hormone levels	Medical management: Octreotide Bromocriptine Surgical management: Endonasal transsphenoidal surgery Radiation therapy
Corticotroph adenoma: Cushing's syndrome	Clinical features of Cushing's syndrome are due to increased level of cortisol: Rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity) Proximal muscle weakness A round face often referred to as a "moon face" Excess sweating Headache The excess cortisol may also affect other endocrine systems and cause, for example Insomnia Reduced libido Impotence Amenorrhoea Infertility Patients frequently suffer various psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety are also common.	Dexamethasone suppression test 24 hour urinary measurement of cortisol	Medical management: Pasireotide Cabergoline, Ketoconazole Metyrapone Mitotane Mifepristone Surgical management: Transsphenoidal pituitary resection
Hypothyroidism	Clinical features of hypothyroidism are due to deficiency of thyroxine: Fatigue Cold intolerance Decreased sweating Hypothermia Coarse skin Weight gain Hoarseness Goiter Fullness in the throat and neck Depression Emotional lability Attention deficit	Elevated TSH Low T4 Low T3 Elevated Anti-thyroid antibodies(TPOAb)	Levothyroxine
Chronic renal failure	There are no pathognomonic symptoms associated with chronic renal failure. Common non-specific symptoms of chronic renal failure are: Malaise nausea unintentional weight loss pruritus lower extremity edema sleep disorders	Renal function tests	Medical management: Blood pressure management Control of blood glucose Protein restriction Management of anemia Management of electrolyte disturbance Dialysis Surgical management Kidney transplant
Cirrhosis		Liver function tests
Viral hepatitis		Viral markers
Seizure disorder		Electroencephalogram

References

↑ Rigg LA, Lein A, Yen SS (1977). "Pattern of increase in circulating prolactin levels during human gestation". Am J Obstet Gynecol. 129 (4): 454–6. PMID 910825.
↑ Levy A (2004). "Pituitary disease: presentation, diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 3: iii47–52. doi:10.1136/jnnp.2004.045740. PMC 1765669. PMID 15316045.
↑ Snyder PJ, Jacobs LS, Utiger RD, Daughaday WH (1973). "Thyroid hormone inhibition of the prolactin response to thyrotropin-releasing hormone". J Clin Invest. 52 (9): 2324–9. doi:10.1172/JCI107421. PMC 333037. PMID 4199418.
↑ Sievertsen GD, Lim VS, Nakawatase C, Frohman LA (1980). "Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure". J Clin Endocrinol Metab. 50 (5): 846–52. doi:10.1210/jcem-50-5-846. PMID 7372775.
↑ Jha SK, Kannan S (2016). "Serum prolactin in patients with liver disease in comparison with healthy adults: A preliminary cross-sectional study". Int J Appl Basic Med Res. 6 (1): 8–10. doi:10.4103/2229-516X.173984. PMC 4765284. PMID 26958514.
↑ Ben-Menachem, Elinor (2006). "Is Prolactin a Clinically Useful Measure of Epilepsy?". Epilepsy Currents. 6 (3): 78–79. doi:10.1111/j.1535-7511.2006.00104.x. ISSN 1535-7597.
↑ David SR, Taylor CC, Kinon BJ, Breier A (2000). "The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia". Clin Ther. 22 (9): 1085–96. doi:10.1016/S0149-2918(00)80086-7. PMID 11048906.
↑ McCallum RW, Sowers JR, Hershman JM, Sturdevant RA (1976). "Metoclopramide stimulates prolactin secretion in man". J Clin Endocrinol Metab. 42 (6): 1148–52. doi:10.1210/jcem-42-6-1148. PMID 777023.
↑ Sowers JR, Sharp B, McCallum RW (1982). "Effect of domperidone, an extracerebral inhibitor of dopamine receptors, on thyrotropin, prolactin, renin, aldosterone, and 18-hydroxycorticosterone secretion in man". J Clin Endocrinol Metab. 54 (4): 869–71. doi:10.1210/jcem-54-4-869. PMID 7037817.
↑ Steiner J, Cassar J, Mashiter K, Dawes I, Fraser TR, Breckenridge A (1976). "Effects of methyldopa on prolactin and growth hormone". Br Med J. 1 (6019): 1186–8. PMC 1639736. PMID 1268617.
↑ Fearrington EL, Rand CH, Rose JD (1983). "Hyperprolactinemia-galactorrhea induced by verapamil". Am J Cardiol. 51 (8): 1466–7. PMID 6682619.

Template:WikiDoc Sources

[pmid910825-1] Rigg LA, Lein A, Yen SS (1977). "Pattern of increase in circulating prolactin levels during human gestation". Am J Obstet Gynecol. 129 (4): 454–6. PMID 910825.

[pmid15316045-2] Levy A (2004). "Pituitary disease: presentation, diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 3: iii47–52. doi:10.1136/jnnp.2004.045740. PMC 1765669. PMID 15316045.

[pmid4199418-3] Snyder PJ, Jacobs LS, Utiger RD, Daughaday WH (1973). "Thyroid hormone inhibition of the prolactin response to thyrotropin-releasing hormone". J Clin Invest. 52 (9): 2324–9. doi:10.1172/JCI107421. PMC 333037. PMID 4199418.

[pmid7372775-4] Sievertsen GD, Lim VS, Nakawatase C, Frohman LA (1980). "Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure". J Clin Endocrinol Metab. 50 (5): 846–52. doi:10.1210/jcem-50-5-846. PMID 7372775.

[pmid26958514-5] Jha SK, Kannan S (2016). "Serum prolactin in patients with liver disease in comparison with healthy adults: A preliminary cross-sectional study". Int J Appl Basic Med Res. 6 (1): 8–10. doi:10.4103/2229-516X.173984. PMC 4765284. PMID 26958514.

[Ben-Menachem2006-6] Ben-Menachem, Elinor (2006). "Is Prolactin a Clinically Useful Measure of Epilepsy?". Epilepsy Currents. 6 (3): 78–79. doi:10.1111/j.1535-7511.2006.00104.x. ISSN 1535-7597.

[pmid11048906-7] David SR, Taylor CC, Kinon BJ, Breier A (2000). "The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia". Clin Ther. 22 (9): 1085–96. doi:10.1016/S0149-2918(00)80086-7. PMID 11048906.

[pmid777023-8] McCallum RW, Sowers JR, Hershman JM, Sturdevant RA (1976). "Metoclopramide stimulates prolactin secretion in man". J Clin Endocrinol Metab. 42 (6): 1148–52. doi:10.1210/jcem-42-6-1148. PMID 777023.

[pmid7037817-9] Sowers JR, Sharp B, McCallum RW (1982). "Effect of domperidone, an extracerebral inhibitor of dopamine receptors, on thyrotropin, prolactin, renin, aldosterone, and 18-hydroxycorticosterone secretion in man". J Clin Endocrinol Metab. 54 (4): 869–71. doi:10.1210/jcem-54-4-869. PMID 7037817.

[pmid1268617-10] Steiner J, Cassar J, Mashiter K, Dawes I, Fraser TR, Breckenridge A (1976). "Effects of methyldopa on prolactin and growth hormone". Br Med J. 1 (6019): 1186–8. PMC 1639736. PMID 1268617.

[pmid6682619-11] Fearrington EL, Rand CH, Rose JD (1983). "Hyperprolactinemia-galactorrhea induced by verapamil". Am J Cardiol. 51 (8): 1466–7. PMID 6682619.

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@@ Line 12: / Line 12: @@
 #'''[[Physiological]]:'''
 #*Normal [[pregnancy]]<ref name="pmid910825">{{cite journal| author=Rigg LA, Lein A, Yen SS| title=Pattern of increase in circulating prolactin levels during human gestation. | journal=Am J Obstet Gynecol | year= 1977 | volume= 129 | issue= 4 | pages= 454-6 | pmid=910825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=910825  }} </ref>
-#'''[[Pathological]]:'''
+#'''[[Pathological]]:'''[[Pituitary tumors]] (other than prolactinoma):<ref name="pmid15316045">{{cite journal| author=Levy A| title=Pituitary disease: presentation, diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 3 | issue=  | pages= iii47-52 | pmid=15316045 | doi=10.1136/jnnp.2004.045740 | pmc=1765669 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15316045  }} </ref>
-#*[[Pituitary tumors]] (other than prolactinoma):<ref name="pmid15316045">{{cite journal| author=Levy A| title=Pituitary disease: presentation, diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 3 | issue=  | pages= iii47-52 | pmid=15316045 | doi=10.1136/jnnp.2004.045740 | pmc=1765669 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15316045  }} </ref>
+#*[[Somatotroph adenoma]]: [[Acromegaly]]
-#**[[Somatotroph adenoma]]: [[Acromegaly]]
+#*[[ACTH-secreting tumor|Corticotroph adenoma]]: [[Cushing's syndrome]]
-#**[[ACTH-secreting tumor|Corticotroph adenoma]]: [[Cushing's syndrome]]
 #*Supra [[Sella turcica|seller]] tumors(tumors present in region of [[pituitary stalk]])
 #*[[Hypothyroidism]]<ref name="pmid4199418">{{cite journal| author=Snyder PJ, Jacobs LS, Utiger RD, Daughaday WH| title=Thyroid hormone inhibition of the prolactin response to thyrotropin-releasing hormone. | journal=J Clin Invest | year= 1973 | volume= 52 | issue= 9 | pages= 2324-9 | pmid=4199418 | doi=10.1172/JCI107421 | pmc=333037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4199418  }} </ref>
@@ Line 33: / Line 33: @@
 #**[[Methyldopa]]<ref name="pmid1268617">{{cite journal| author=Steiner J, Cassar J, Mashiter K, Dawes I, Fraser TR, Breckenridge A| title=Effects of methyldopa on prolactin and growth hormone. | journal=Br Med J | year= 1976 | volume= 1 | issue= 6019 | pages= 1186-8 | pmid=1268617 | doi= | pmc=1639736 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1268617  }} </ref>
 #**[[Verapamil]]<ref name="pmid6682619">{{cite journal| author=Fearrington EL, Rand CH, Rose JD| title=Hyperprolactinemia-galactorrhea induced by verapamil. | journal=Am J Cardiol | year= 1983 | volume= 51 | issue= 8 | pages= 1466-7 | pmid=6682619 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6682619  }} </ref>
+{| class="wikitable"
+!Disease
+!Clinical Findings
+!Laboratory findings
+!Management
+|-
+|[[Somatotroph adenoma]]:
+[[Acromegaly]]
+|Clinical features of acromegaly are due to high level of [[Growth hormone|human growth hormone]]([[Growth hormone|hGH]]):
+* Soft tissue swelling of the hands and feet
+* Brow and lower jaw protrusion
+* Enlarging hands
+* Enlarging feet
+* [[Arthritis]] and [[carpal tunnel syndrome]]
+* Increase in teeth spacing
+* [[Macroglossia]] [enlarged tongue]
+* [[Heart failure]]
+* [[Kidney failure]]
+* Compression of the [[optic chiasm]] leading to loss of vision in the outer visual fields (typically [[bitemporal hemianopia]])
+* [[Headache]]
+* [[Diabetes mellitus]]
+* [[Hypertension]]
+* [[Cardiomegaly]]
+|
+* Elevated [[insulin-like growth factor-1]] ([[Insulin-like growth factor-I|IGF-1]]) levels
+* Elevated [[growth hormone]] levels
+|
+* Medical management:
+** [[Octreotide]]
+** [[Bromocriptine]]
+* Surgical management:
+** Endonasal transsphenoidal surgery
+* Radiation therapy
+|-
+|[[ACTH-secreting tumor|Corticotroph adenoma]]: [[Cushing's syndrome]]
+|Clinical features of [[Cushing's syndrome]] are due to increased level of [[cortisol]]:
+* Rapid [[Obesity|weight gain]], particularly of the trunk and face with sparing of the limbs ([[central obesity]])
+* Proximal muscle weakness
+* A round face often referred to as a "[[moon face]]"
+* Excess [[sweating]]
+* Headache
+* The excess cortisol may also affect other endocrine systems and cause, for example
+** [[Insomnia]]
+** Reduced [[libido]]
+** [[Impotence]]
+** [[Amenorrhoea]]
+** [[Infertility]]
+* Patients frequently suffer various psychological disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[Clinical depression|Depression]] and [[anxiety]] are also common.
+|
+* Dexamethasone suppression test
+* 24 hour urinary measurement of cortisol
+|
+* Medical management:
+** [[Pasireotide]]
+** [[Cabergoline]],
+** [[Ketoconazole]]
+** [[Metyrapone]]
+** [[Mitotane]]
+** [[Mifepristone]]
+* Surgical management:
+** Transsphenoidal pituitary resection
+|-
+|[[Hypothyroidism]]
+|Clinical features of [[hypothyroidism]] are due to deficiency of [[thyroxine]]:
+* [[Fatigue]]
+* Cold intolerance
+* Decreased sweating
+* [[Hypothermia]]
+* Coarse skin
+* [[Weight gain]]
+* [[Hoarseness]]
+* [[Goiter]]
+* Fullness in the throat and neck
+* [[Depression]]
+* [[Emotional lability]]
+* [[Attention deficit]]
+|
+* Elevated [[Thyroid-stimulating hormone|TSH]]
+* Low [[Thyroxine|T4]]
+* Low [[Triiodothyronine|T3]]
+* Elevated Anti-thyroid antibodies(TPOAb)
+|[[Levothyroxine]]
+|-
+|[[Chronic renal failure]]
+|There are no pathognomonic symptoms associated with chronic renal failure. Common non-specific symptoms of chronic renal failure are:
+* [[Malaise]]
+* [[nausea]]
+* unintentional [[weight loss]]
+* [[pruritus]]
+* [[lower extremity edema]]
+* [[sleep disorders]]
+|[[Renal function tests]]
+|
+* Medical management:
+** [[Blood pressure medication|Blood pressure management]]
+** Control of [[Blood sugar|blood glucose]]
+** Protein restriction
+** Management of [[anemia]]
+** Management of [[electrolyte disturbance]]
+** [[Dialysis]]
+* Surgical management
+** [[Kidney transplant]]
+|-
+|[[Cirrhosis]]
+|
+|[[Liver function tests]]
+|
+|-
+|[[Viral hepatitis]]
+|
+|Viral markers
+|
+|-
+|[[Seizure|Seizure disorder]]
+|
+|[[Electroencephalogram]]
+|
+|}
 == References ==

Prolactinoma differential diagnosis: Difference between revisions

Revision as of 18:19, 20 July 2017

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