Hyperprolactinemia Is the elevation of prolactine hormone which is secreted from anterior pituitary gland

Objective The causes of hyperprolactinemia The presentation of hyper prolactinemia Treatment of hyper prolactinemia

Causes of hyperprolactinemia A-physiological causes : 1- idiopathic 2- pregnancy 3- postpartum 4- sleep 5- stress 6-major surgery 7-intercourse B-Hypothalamic condition. 1-craniopharangioma 2-tuberculosis 3- cystic glyoma C-Pituitary condition . 1-acromegaly 2-addisons disease 3-cushing syndrome 4-hypothyrodism 5-pituitary adenoma(micro adenoma ,macrodenoma) 6-metastatic tumor . D-metabolic dysfunction 1-hepatic cirrhosis 2-renal failure .

E-Drugs Methyl dopa , cimitidine, antidepressant (imipramine), Phenothiasine ,metclorpromide . Clinical presentation. The patient may present with amenorrhea or galictorrhea or disturbance of menstruation or infertility . Investigations : Review the history ,physical examination, exclude the physiological causes , drugs . 1- prolactine level by radio immunoassay .

4- CT and MRI for the diagnosis of the pituitary tumor Treatment : 2-T.S.H.for assessment of thyroid function 3-X ray of the sella tursica to see any destruction by macro adenoma of the pituitary gland 4- CT and MRI for the diagnosis of the pituitary tumor Treatment : Medical treatment with dopamine agonist (bromocriptine)trade name parlodil start with low dose then increase gradually , side effects nausea vomiting , nasal congestion .Alternative is gabergoline (dostinex)given once weekly. Macroadenoma of the pituitary gland initially treated by medical treatment assess the size of tumor if persist or causing visual defect neurosurgery done .

Hirsuitism The growth of terminal hair on the body of a women in the same pattern and sequence of that adult male. Causes: 1- idiopathic 2-polycystic ovary 3-androgen secreting tumor e.g. that of ovary 4-congenital adrenal hyperplasia 5-cushing syndrome Treatment: 1- Oral contraception pills by decreasing ovarian androgen and by increase sex binding globulin

2- Cyproterone acetate (andrucure) anti androgen should be given with O.C.P to prevent pregnancy because it is teratogen. 3-Spirinolactone(aldactone)by blocking the receptor for androgen. Non pharmacological: 1-Bleeching agent like hydrogen peroxide which remove the hair color . 2-shaving. 3-Elctrolysis perminant destruction of hair follicles . 4-Lazer

Virilism Is excessive androgen secretion which cause musculinization of female , hirsuitism ,horsiness of voice , enlargement or hypertrophy of clitoris ,baldness of female .