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Thyroid, Pregnenolone, Progesterone, DHEA, etc
Thyroid, DHEA, Pregnenolone, Progesterone, etc
Clinical practice: prolactin-secreting tumors
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<blockquote data-quote="madman" data-source="post: 226794" data-attributes="member: 13851"><p><strong>Box 1. <u>Tips and tricks</u> </strong></p><p></p><p><em><strong>1. Serum prolactin (PRL) should be measured only in specific clinical settings, such as menstrual disturbances, erectile dysfunction, loss of libido, infertility, or imaging showing a lesion in the hypothalamic-pituitary region </strong></em></p><p><em><strong></strong></em></p><p><em><strong>2. The insertion of an i.v. catheter 15–20 min before sampling for PRL assay in the diagnostic phase is a simple and practical tool for the confirmation of the diagnosis in cases of mild hyperprolactinemia (<80–100 ng/mL) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>3. Try to identify the cause of hyperprolactinemia, including iatrogenic and other causes different from PRL-secreting tumors (see text for details) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>4. Do not start treatment with dopamine agonist (DA) drugs without a diagnosis and a pituitary MRI if appropriate </strong></em></p><p><em><strong></strong></em></p><p><em><strong>5. The magnitude of PRL levels in macroadenomas often enables us to differentiate between ‘true’ prolactinomas and ‘pseudoprolactinomas’ (see text for details) </strong></em></p><p><em><strong></strong></em></p><p><em><strong>6. The management should be guided by clinics and not only by ‘numbers’ </strong></em></p><p><em><strong></strong></em></p><p><em><strong>7. Patient’s wishes should be taken into account in the management </strong></em></p><p><em><strong></strong></em></p><p><em><strong>8. Do not forget hypopituitarism</strong></em></p><p></p><p> <em><strong>9. Single PRL measurement is adequate during DA treatment</strong></em></p><p></p><p> <em><strong>10. In patients on chronic DA treatment, no particular timing is required for PRL sampling </strong></em></p><p><em><strong></strong></em></p><p><em><strong>11. During intercurrent illness or scheduled hospitalization, chronic DA treatment should be continued </strong></em></p><p><em><strong></strong></em></p><p><em><strong>12. Alert the patient and caregivers about the possible DA-induced impulse control disorder </strong></em></p><p><em><strong></strong></em></p><p><em><strong>13. Advice female patients to plan pregnancy and provide easily accessible medical support to pregnant women. 14. The choice about delivery and breastfeeding should be shared with the endocrinologist. 15. In complex cases, do not hesitate to refer patients to experts: aggressive tumors should be treate</strong></em><strong>d by a pituitary multidisciplinary team</strong></p></blockquote><p></p>
[QUOTE="madman, post: 226794, member: 13851"] [B]Box 1. [U]Tips and tricks[/U] [/B] [I][B]1. Serum prolactin (PRL) should be measured only in specific clinical settings, such as menstrual disturbances, erectile dysfunction, loss of libido, infertility, or imaging showing a lesion in the hypothalamic-pituitary region 2. The insertion of an i.v. catheter 15–20 min before sampling for PRL assay in the diagnostic phase is a simple and practical tool for the confirmation of the diagnosis in cases of mild hyperprolactinemia (<80–100 ng/mL) 3. Try to identify the cause of hyperprolactinemia, including iatrogenic and other causes different from PRL-secreting tumors (see text for details) 4. Do not start treatment with dopamine agonist (DA) drugs without a diagnosis and a pituitary MRI if appropriate 5. The magnitude of PRL levels in macroadenomas often enables us to differentiate between ‘true’ prolactinomas and ‘pseudoprolactinomas’ (see text for details) 6. The management should be guided by clinics and not only by ‘numbers’ 7. Patient’s wishes should be taken into account in the management 8. Do not forget hypopituitarism[/B][/I] [I][B]9. Single PRL measurement is adequate during DA treatment[/B][/I] [I][B]10. In patients on chronic DA treatment, no particular timing is required for PRL sampling 11. During intercurrent illness or scheduled hospitalization, chronic DA treatment should be continued 12. Alert the patient and caregivers about the possible DA-induced impulse control disorder 13. Advice female patients to plan pregnancy and provide easily accessible medical support to pregnant women. 14. The choice about delivery and breastfeeding should be shared with the endocrinologist. 15. In complex cases, do not hesitate to refer patients to experts: aggressive tumors should be treate[/B][/I][B]d by a pituitary multidisciplinary team[/B] [/QUOTE]
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Thyroid, Pregnenolone, Progesterone, DHEA, etc
Thyroid, DHEA, Pregnenolone, Progesterone, etc
Clinical practice: prolactin-secreting tumors
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