<prompt> Which level of Prolactin definitely suggest Prolactinoma?50 mgL100 mgL150 mgL200 mgL  <response>: D 200mgLLesions of hypothalamic-pituitary lesion that disrupt hypothalamic dopamine synthesis, portal vessel delivery or lacto-trope responses are associated with Hyperprolactinemia.oHYPERPROLACTINEMIA is the most common pituitary hormone hyper-secretion syndrome in both men women.oDegree of hyperprolactinemia is usually related to the size of Prolactinoma.oPRL secreting - pituitary adenomas prolatcinomas are the most common cause of PRL level 200mgLoDiagnosis of Prolactinoma is likely with a PRL level 200mgL oPRL levels 100mgL may be caused by Microadenomas. oMicroprolactinomas seen with less pronounced PRL elevation is more commonly caused by drugs, pituitary stalk compression, hypothyroidism or renal failure.oMacroprolactinoma is usually associated with serum PRL levels 250mgL.oA serum PRL level 500mgL makes the diagnosis of macroprolactinoma almost certain.oMost common hormone-secreting pituitary tumors, approximately 40 of all pituitary tumorsoMicroprolactinomas more commonoProlactin PRL 200mgmL.oLevels between 20-200 could be due to a prolactinoma or any other sellar massoOccur most frequently in females aged 20-50 years, gender ratio of 10:1oMen: decreased libido, galactorrheaoWomen: amenorrhea, galactorrheaoOccasionally prolactin is co-secreted with GH causing clinical syndrome of both prolactinemia and acromegaly?Assessment of HYPERPROLACTINEMIA:oProlactin Values:-Prolactin levels correlates with tumor size:-Normal prolactin levels: 9-25mgL;50mgL Functional Hyperprolactinemia-Between 50-100mgL Microprolactinomas; Over 200mgL Macroprolactinomas-Bromocriptine test:-2.5 mg bromocriptine must reduce prolactin levels,-Assessment of lesions: CT, MRI-MRI should be performed in all patients with hyperprolactinemia.?Hyperprolactinemia:oInvestigation:-Prolactin level - are increased:-Mild increase in Prolactin level 400-600mUL may be physiological, level above 5000mUL always imply Prolactin secreting pituitary tumor.-Visual field.-Exclude primary hypothyroidism-Radiology for pituitary tumor. MRI of pituitary when Prolactin level above 1000mULPROLACTIN PLASMA CONCENTRATIONS. Normal2.5-17mgL Men1.9-25mgL Women. HighFrom 30-60 to 150-200mgLProlactinoma. Macroprolactinomas 1 cm in diameter50-300mgLcan be as low as 30mgL. Macroprolactinomas 1 cm in diameter200-5,000mgLcan be as high as 35,000mgL?Pituitary Adenoma:oProlactinoma:-30 of pituitary adenomas-More commonly microdenomas-Present as amenorrhea with galactorrhea-Prolactin levels 200mgL if less worry about stalk effect-First line treatment is pharmacological-Dopamine agonists bromocriptine?Prolactin:o25mgL; Normalo25-150mgL: Prolactinoma; Stalk effect; Drugs; Hypothyroido150mgL: ProlactinomaoHook effect: Even large elevations will show normal PRL levels on testing due to large size of molecules.oDo serial dilution. 