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Knowledge Area 12: Sexual and Reproductive Health
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
COCPs increase the risk of thromboembolism (deep venous thrombosis and pulmonary embolism), myocardial infarction and thrombotic strokes. It shows no association with prolactinomas and trophoblastic disease.Further readingFSRH clinical guideline: Combined hormonal contraception. January 2019, Amended July 2019. https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/
Dopamine and Tumorigenesis in Reproductive Tissues
Published in Nira Ben-Jonathan, Dopamine, 2020
The mechanisms underlying prolactinoma formation are enigmatic. More than any other pituitary cell type, lactotrophs have considerable plasticity, and increase both in number and size under various physiological conditions, e.g., during human pregnancy, and in response to inappropriate estrogen exposure in certain strains of rats. The increase in lactotroph number is attributed to the combined effects of increased cell division, reduced apoptosis, and trans-differentiation of lactotrophs from other pituitary cell types, primarily bifunctional somatolactotrophs. Yet, unlike the typical malignant transformation of epithelial cells elsewhere, lactotrophs undergo only the initial stage of tumorigenesis, i.e., uncontrolled cell growth, but do not progress into bona fide carcinomas. Consequently, prolactinomas lack most markers of malignancy such as high mitotic index, dedifferentiation, and metastasis.
Primary Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Christopher M. Jones, John Ayuk
Human prolactin is a protein consisting of 199 amino acids. It has similarities with GH and, though its predominant and most active form is a monomer, it also circulates as a dimer and polymer. Serum assessment of prolactin level is a reliable measure of this hormone and is used for both the diagnosis of prolactinoma and to monitor the effect of treatment. Circulating levels are higher in women than in men.
Pituitary apoplexy of a giant prolactinoma during pregnancy
Published in Gynecological Endocrinology, 2021
Safa Khaldi, Ghada Saad, Hamza Elfekih, Asma Ben Abdelkrim, Taieb Ach, Maha Kacem, Molka Chaieb, Amel Maaroufi, Yosra Hasni, Koussay Ach
Prolactinomas are the most frequent type of pituitary adenoma in women and they represent a common cause of anovulation and female infertility [1]. Giant prolactinomas are a subset of macroadenomas, accounting for only 2–3% of prolactinomas [2]. They are defined as prolactinomas greater than 4 cm in size [2]. They are associated with prolactin (PRL) levels >1000 ng/mL and typically result in clinical symptoms such as galactorrhea or mass effects [3]. Although prolactinomas are benign, giant ones are often locally aggressive, invading surrounding structures [3]. These tumors are extremely rare in women with a male: female ratio of 9:1 [4]. This is usually attributed to early detection of the disease, easily identified by endocrine symptoms in women [3]. Cabergoline is currently the treatment of choice for symptomatic prolactinomas since it has higher efficacy in normalizing PRL levels and in decreasing tumor size [5]. Restoration of gonadal function and the occurrence of pregnancy raise two questions: What will be the effect of pregnancy on tumor growth? What will be the effect of dopamine agonists on fetal development and pregnancy outcomes? The answers are few given the limited number of cases reported in the literature. Our clinical case of a young woman with a giant prolactinoma, confirmed histologically, with restoration of fertility is the fourth case reported in the literature to the best of our knowledge [6–8].
Ocular manifestations of endocrine disorders
Published in Clinical and Experimental Optometry, 2022
M Hossein Nowroozzadeh, Sarah Thornton, Alison Watson, Zeba A Syed, Reza Razeghinejad
Radiation therapy may be utilized for recurrent or residual tumours but is not the first-line due to delayed efficacy and risk of damage to local structures.84 Neurosurgical decompression also may be necessary for the treatment of Rathke’s cleft cyst or craniopharyngioma. For prolactinomas, medical therapy with dopamine agonists is often successfully used to reduce tumour size and serum prolactin levels. Asymptomatic, incidentally detected pituitary microadenomas might often be observed.22
Hyperprolactinaemia in male infertility: Clinical case scenarios
Published in Arab Journal of Urology, 2018
Zeinab Dabbous, Stephen L Atkin
Prolactinomas (lactotroph adenomas) are the most common pathological cause of hyperprolactinaemia and account for ∼40% of pituitary adenomas [7]. The diagnosis is more commonly made in women than men due to the effect of hyperprolactinaemia on the female menstrual cycle giving an earlier indication of hormonal imbalance. Prolactinomas can be microadenomas (<1 cm in diameter) or macroadenomas (>1 cm in diameter), and the level of serum prolactin measured is directly proportional to the size of the adenoma [7].