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18 Cards in this Set

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  • Back
little PRL
MW=23 kd.
high bioactivity and immunoreactivity
glycosylated PRL
MW=25 kd.
less bioactivity and immunoreactivity than Little PRL
MW=50 kd.
-combo of di- and trimeric G-PRL. decreased receptor binding
Big-big PRL
MW=100 kd.
-G-PRL coupled w/IgG
rel'n b/w hyperprolactinemia and galactorrhea
-Galactorrhea can be present without hyperprolactinemia.\
-immunoreactivity (assay)
vs. bioactivity
-60% pts w/galactorrhea have hyper-PRL
waht stimulates/inhibits PRL secretion
Stimulates PRL:

Inhibit PRL:
-DA (pit stalk interruption==>PRL release d/t loss of DA)
effects of Pregnancy on PRL
-PRL rises soon after implantation (PRL rises w/estrogen), but no milk secreted b/c progesterone inhbiits expression of PRL receptors in breast
effects of nursing on PRL
-suckling==>incr PRL==>produces milk for subsequent feeding
what does oxytocin do
causes milk let-down
hourly variation of PRL: EXAM
-highest PRL during nocturnal sleep (3 am)
-lowest PRL in morning (9-11am)
-PRL incr with protein at lunch time
-best times to measure PRL:
conditions assoc w/incr PRL release
1. preg
2. nursing
3. sleep
4. food
5. stress
6. orgasm
7. breast stimulation (eg breast exam)
Inappropriate PRL secretion
A. Central causes
1. Hypothalamic
-hypo stalk resection
2. Pit
a. Adenoma (secrete PRL)
-microadenoma (<=10mm)
-macroadenoma (>10mm)

B. Peripheral causes
1. Hypothyroidism (incr TRH)
2. Chest Wall Reflex
3. Renal failure==>decr renal Clearance of PRL
4. Ectopic:
a.bronchogenic carcioma

C. Drugs
1. Anesthesia
2. Psychoactive agents:
a.neuroleptics (DA antagonist)
b.TCA (incr precursors)
c. diazepam
d. antihyerptensives
consequences of hyperprolactinemia
A. Galactorrhea
B. Mastalgia (breast pain)
C. Menstrual Abnl
1. Hypoestronism
2. bone loss
(incr PRL==>incr DA (positive feedback)==>decr GnRH pulsatility
==>anovulatory or amenorrhea
D. Hyper-androgenism
E. Insulin resistance
galactorrhea workup
-check fasting AM prolactin level
-PE: microscopic- fat droplets
Tx Hyper-PRL
bromocriptine or cabergoline (DA analogs)
Microadenomas: Management

A. Expectant management
*if follows a benign course, microadenoma growth is slow
*no Tx req unless:
-want to get pregnant,
-hypoestrogenemia exists,
-galactorrhea is bothersome

B. **Management is based on menses

1. Regular menses==>Expectant
a.yearly PRL levels

2. Oligomenorrheic
a.cyclic progestin
b. OCP's

3. Hypoestrogenic
a. Estrogen Replacement
b. OCP's

C. Medical management (with bromocriptine)
-90% euprolactinemic (nl PRL levels)
-decr adenoma size
-80% fertility
-60% stop galactorrhea
-After discontinuing bromocriptine:
-following 1 yr Tx:
10-20% remain euprolactinemic after d/c bromocriptine
-following 2 yr Tx:
22% euprolactinemic
Macroadenoma: Management
-Thyroid function tests
-Adrenal function: do insulin tolerance test
-DOC= Bromocriptine for 6 months
-Surgery (transphenoidal or transfrontal) not great b/c high rate of recurrence
how Tx women with PRL-secreting tumors
bromocriptine (it's safe, no effect on placental fxn
also, it's safe to breastfeed)