Things - 4th /5thstage
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Things that might or might not help u with your finals .. This channel is NOT responsible for anything. "remember this, you can start over each morning" 💚 - Taylor joseph / Hasnaa shndi.
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Mangment:
investigation:
1-prolactin release. 360ng/ml
2-Tests of gonadal function .amenorrhea anavulatory cycle with infiltrity
3-TSH measured to exclude primary hypothyroidism. (2.2mlu/l)
4-comprehensive metabolic panel.
5-pregnancy test -ve
6-Screening for hypopituitarism should be considered in all patients with macroprolactinomas.
7-MRI with gadolinium enhancement provides the best anatomic detail of the hypothalamic-pituitary area.
8-Visual field testing should be obtained in patients with tumors that are adjacent to or compressing the optic chiasm.
treatment:
1-treatment underlying cause
2- Dopamine agonist is the first line treatment of hyperprolactimia.
normalize PRL levels and correct amenorrhea ,galactorrhea in 80 to 90% of patients.
Cabergoline is more effective, has fewer adverse side effects than bromocriptine, andcan be taken once or twice weekly. Bromocriptine must be started in low doses with gradual increases to avoid side effects(nausea, dizziness, somnolence, and nasalstuffiness).
3- if the patient suspected to have macroadenoma always treated even if not cause compression symptoms. start with medical treatment and surgery indicated in
1-macroprolactinoma has failed to shrink sufficientlywith dopamine agonist therapy .
2.Surgery may also be performed in patients in tolerant to dopamine agonist .
microprolactinomas require treatment only when symptoms caused by hyperprolactinemia or rapidly increasing prolactin levels indicative of an enlarging tumor are present.
primary adrenal insufficiency/ drugs are essential for treatment his condition glucocorticoid ,usually mineralocorticoid and androgen . hydrocortisone is treatment of choice . should be giving by mouth 15-10mg on waking and 5mg after 15/18 hr . and fludrocortison 0.05-0.1mg per oral .patient should also mantain ample intake of sodium (3-4g/d).
and monitor for under or over replacement therapy.
