clinical case study gonads

8/10/2019 Clinical Case Study Gonads

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CLINICAL CASE STUDIE

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What impact does hyperprolactenemiahave on reproductive functions ?

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What is the treatment formicroprolactinemia/microadenoma?

For symptomatic microadenomas, therapeutic goals include:

control of hyperprolactinemia reduction of tumor size restoration of menses and fertility,

resolution of galactorrhea.Dopamine agonist doses should be titrated to achieve maximal PRL suppressionand restoration of reproductive function

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Medical Therapy

Oral dopamine agonists

cabergoline and bromocriptinemainstay of therapy for patients with micro- macroprolactinomas

Action :suppress PRL secretion and synthesis as well as lactotrope cellproliferation.

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In patients with microadenomas who have achieved normoprolactinemand significant reduction of tumor mass:

the dopamine agonist may be withdrawn after 2 years.

These patients should be monitored carefully for evidence ofprolactinoma recurrence.

20% of patients (especially males)resistant to dopaminergic treatment; these adenomas may exhibit decreased D 2 dopamine receptor numbeor a postreceptor defect

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Bromocriptine

dopamine receptor agonist that suppresses prolactin secretion.it is short-acting the drug is preferred when pregnancy is desired

Therapy is initiated by administering a low bromocriptine dose(0.625 1.25 mg) at bedtime with a snack, followed by gradually increa

dose.Most patients are controlled with a daily dose of 7.5 mg (2.5 mg

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Patients w/ microadenomas : bromocriptine rapidly lowers serum prolactin levels to

normal in up to 70% of patients,decreases tumor size, restores gonadal function.

patients with macroadenomas : prolactin levels are also normalized in70% of patients tumormass shrinkage ( 50%) is achieved in most patients.

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Side effects of dopamine agonists

constipationnasal stuffiness

dry mouth nightmaresinsomniaVertigo

decreasing the dose usually alleviates these problems

May occur in 25% of patients after the initial dose:Nausea,Vomitingpostural hypotension with faintness.

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Intravaginal administration of bromocriptine :is often efficacious in patients with intractable gastrointestinalside effects .

Auditory hallucinations, delusions, and mood swingshave been reported in up to 5% of patientsmay be due to the dopamine agonist properties or to the lysergicacid derivative of the compounds.

risk for development of cardiac valve regurgitation :

Patients with Parkinsons disease who receive at least 3 mg ofcabergoline daily

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Radiotherapy for prolactinomas i:

reserved for patients withaggressive tumors that do notrespond to maximally tolerateddopamine agonists and/or surgery.

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The pituitary increases in size during pregnancy,

reflecting the stimulatory effects of estrogen and perhaps othergrowth factors on pituitary vascularity and lactotrope cell hyperplasia

About 5% of microadenomas significantly increase in size, but 15 macroadenomas grow during pregnancy.

Bromocriptine has been used for more than 30 years to restore fertility inwomen with hyperprolactinemia, without evidence of teratogenic effects.

PREGNANCY

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.For women taking bromocriptine who desire pregnancy,:

mechanical contraceptionshould be used through three regular menstcycles to allow for conception timing .

When pregnancy is confirmed, bromocriptine should be discontinued PRL levels followed serially, especially if headaches or visual symptomsoccur.

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.For women harboring macroadenomas

regular visual field testing is recommended, and the drug should bereinstituted if tumor growth is apparent.

Although pituitary MRI may be safe during pregnancy, this procedure sbe reserved for symptomaticpatients with severe headache and/or visual field defects.

Surgical decompression may be indicated if vision is threatened

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clinical case study gonads

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