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Prolactin

By AdminPosted On 05-Oct-2016

1. Prolactin Level

General guidelines for diagnosing prolactin excess (hyperprolactinemia) define the upper threshold of normal prolactin at 25 µg/L for women. It is done commonly for three indications

1. Abnormal nipple discharge

2. Menstrual irregularity of no menses (amenorrhea)

3. Infertility

The recommended dosage of Cabergoline tablets for initiation of therapy for high prolactin level is 0.25 mg twice a week. Dosage may be increased by 0.25 mg twice weekly up to a dosage of 1 mg twice a week according to the patient’s serum prolactin level.


2. Lactation Suppression

All the following methods inhibit lactation EXCEPT :


a) Restriction of fluid and diuretics

b) Tight breast binder and analgesics

c) Estrogen hormone in large dose

d) Thyroxin hormone e) Dopamine agonist

Correct Answer: a) Restriction of fluid and diuretics. Available evidence suggests that women who wish to suppress lactation should receive bromocriptine-related medications (e.g. cabergoline). Estrogen preparations are not recommended as they were studied in older trials. (Ref: WHO)


Single oral dose of 1 mg of Cabergoline is usually sufficient to suppress beast milk production.


Women cannot always breastfeed after birth. Reasons may be because the infant dies or is adopted, or the mother is too ill, or for the well being of the mother or infant. HIV‐positive mothers, particularly those not on antiretroviral drugs during pregnancy, avoid breastfeeding to reduce the risk of passing on the virus to their infants. Some mothers do not breastfeed on personal or social grounds. Clinicians may provide treatment to suppress lactation and reduce these symptoms. Binding the breasts or wearing a tight brassiere, applying an infra‐red lamp, fluid and diet restrictions, external application of jasmine flower and ice packs are tried non‐drug approaches.Available evidence suggests that women who wish to suppress lactation should receive bromocriptine-related medications (e.g. cabergoline). Estrogen preparations are not recommended as they were studied in older trials. (Ref: WHO)


3. What is the most common cause of hyperprolactinaemia ?


a) Macroprolactinoma

b) Microprolactinoma

c) Primary hypothyroidism

d) Renal failure

e) Pituitary stalk interruption syndrome (PSIS)

Correct Answer: c) Primary hypothyroidism.

Other common causes include neuroleptic medication and dopamine D2 receptor anti-emetics.


4. Which hypothalamic hormone stimulates the release of prolactin ?

a) Dopamine

b) Growth hormone releasing hormone

c) Gonadotrophin-releasing hormone

d) Somatostatin

e) Thyrotrophin-releasing hormone

Correct Answer: e) Thyrotropin-releasing hormone.

Thyrotrophin-releasing hormone stimulates the release of TSH and prolactin from the anterior pituitary. Dopamine also released from the hypothalamus inhibits prolactin release.


5. Prolactin secretion is stimulated by

a) Dopamin

b) TRF

c) Diazepam

d) Coitus

e) Venepuncture

Correct Answer: b,c,d,e. Dopamine suppresses prolactin.


6. Suckling releases which hormone from pituitary ?

a) Prolactin

b) Oxytocin

c) Somatostatin

d) Somatomedin

e) Dopamine

Correct Answer: a and b.

Oxytocin and prolactin are the hormones produced during breastfeeding that work together to make milk, establish a letdown, and keep up with the supply and demand of a nursing infant.


7. During which of the following would the serum Prolactin level be highest ?

a) Sleep.

b) Ovulation.

c) Parturition.

d) Menopause.

e) Suckling.

Correct Answer: e) Suckling.

Sucking by the baby on the nipple promotes prolactin release, maintaining the ability to lactate. There is a diurnal as well as an ovulatory cycle in prolactin secretion. In many mammals, there is also a seasonal change in prolactin release. Prolactin levels peak during REM sleep, and in the early morning. Levels can rise after exercise, meals, sexual intercourse, minor surgical procedures, or following epileptic seizures.

During pregnancy, high circulating concentrations of estrogen increase prolactin levels by 10- to 20-fold.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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