1.

Hyperprolactinemia is a condition characterized by excess prolactin, the hormone responsible

for milk production in a woman's breasts.
a. True
b. False

Rationale: Hyperprolactinemia is a condition in which a person has higher-than-normal levels of

the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk
production after childbirth, so high prolactin levels are normal in pregnancy.

2. As to the case presented, what was the cause of the patient’s prolactinemia?
a. Pherphazine
b. Olanzapine
c. Methimazole
d. A & B

Rationale: Medication use is a common cause of hyperprolactinemia, and it is important to

differentiate this cause from pathologic causes, such as prolactinomas. The medications that
most commonly cause hyperprolactinemia are antipsychotic agents, antidepressants,
antihypertensive agents, and drugs that increase bowel motility.

3. What are the signs and symptoms of hyperprolactinemia in women.

a. Oligomenorrhea
b. Infertility
c. Amenorrhea
d. All of the above

Rationale: Women typically present with a history of oligomenorrhea, amenorrhea, or infertility,

which generally results from prolactin suppression of gonadotropin-releasing hormone (GnRH).
Galactorrhea is due to the direct physiologic effect of prolactin on breast epithelial cells.

4. What are the signs and symptoms of hyperprolactinemia in men?

a. Sexual dysfunction
b. High blood pressure
c. Blood in the urine
d. Paresthesia

Rationale: Men typically present with complaints of sexual dysfunction (although the
aforementioned study by Rubio-Abadal et al found the prevalence of sexual dysfunction equal
between men and women), [7] visual problems, or headache and are subsequently diagnosed
with hyperprolactinemia in the evaluation process. Prolactin suppresses GnRH, causing a
decrease in luteinizing hormone and follicle-stimulating hormone, ultimately leading to
decreased serum testosterone levels and hypogonadism. Prolactinoma in men also may cause
neurological symptoms, particularly visual-field defects.

5. Stimulation of the nipples and mammary gland, as occurs during nursing, leads to oxytocin
release.
a. True
b. False
Rationale: Stimulation of the nipples and mammary gland, as occurs during nursing, leads to
prolactin release. This effect appears to be due to a spinal reflex arc that causes release of
prolactin-stimulating hormones from the hypothalamus. Estrogens provide a well-studied
positive control over prolactin synthesis and secretion.

6. A 42-year-old obese woman with type 2 diabetes, diabetic retinopathy, hyper​tension, and
hirsutism presents to discuss an elevated prolactin level of 144.8 ng/mL (normal range, 4.8 to
23.3 ng/mL) found by her Ob-Gyn two months ago. She complained of galactorrhea and no
menses for one year. A repeat prolactin level was also elevated, at 109 ng/mL.

What additional diagnostic tests should be ordered as part of the work-up of galactorrhea and
amenorrhea in this patient?

a. Repeat serum prolactin test

b. Measurements of TSH and free T4
c. Apregnancy test
d. All of the above

Rationale: Laboratory evaluation should include a repeat serum prolactin test, measurements of
TSH and free T4, and a pregnancy test. (A serum testosterone level should be checked in men.)
If the results come back normal and if other diagnoses are excluded, the most likely diagnosis is
a prolactinoma. In this case, a pituitary MRI should be obtained. Visual field testing can be
performed in individuals with specific visual complaints, especially loss or impairment of
peripheral vision.

7. Medication therapy involves treatment with a dopamine antagonist, which directly inhibits
prolactin secretion by the tumor and therefore suppresses tumor growth.
a. True
b. False

Rationale: Medication therapy involves treatment with a dopamine agonist, which directly
inhibits prolactin secretion by the tumor and therefore suppresses tumor growth. The goal of
medication therapy is to suppress the prolactin level to normal range and restore gonadal
function.

8. Dopamine agonist used in Hyperprolactinemia:

a. Paliperidone
b. Bromocriptine
c. Promethazine
d. Metoclopramide

Rationale: The two dopamine agonists used in Hyperprolactinemia are bromocriptine and
cabergoline. Paliperidone, Promethazine and Metoclopramide are dopamine antagonists.

9. Endocrinologists may use medications to suppress prolactin production. If a tumor is

detected, surgery or radiation is sometimes needed.
a. True
 b. False

Rationale: If a tumor is detected, surgery or radiation is sometimes needed. The length and type
of treatment varies for each patient and should be discussed with the doctor.

10. The major effect of prolactinoma is decreased levels of some sex hormones — estrogen in
women and testosterone in men.
a. True
b. False

Rationale: Prolactinoma is a condition in which a noncancerous tumor (adenoma) of the pituitary

gland in your brain overproduces the hormone prolactin. The major effect is decreased levels of
some sex hormones — estrogen in women and testosterone in men.

11. Which among the following is the primary function of prolactin?

a. increase the basal metabolic rate, affect protein synthesis, help regulate long bone
growth and neural maturation
b. stimulate breast epithelial cell proliferation
c. Affects growth and development; stimulates protein production; affects fat distribution
d. Stimulates contraction of uterus and milk ducts in the breast

Rationale: Prolactin assists in pregnancy, causing breasts to grow and develop for milk
production. Choice A is a function of Thyroid hormone, C is a function of Growth hormone, and
D is for Oxytocin.

12. The following are contributing factors to developing hyperprolactinemia, except:

a. Prolactinomas
b. Hypothalamus or Infundibular Stalk Damage
c. Severe Primary Hyperthyroidism
d. Chronic Renal Failure

Rationale: Severe Primary HYPOTHYROIDISM contributes to hyperprolactinemia by detectable

decreased levels of T3/T4, therefore stimulating the production of more TRH which
consequently stimulates pituitary gland to produce prolactin.

13. Also described as non-puerperal, except:

a. Prolactinoma
b. Lactotroph adenoma
c. AOTA
d. NOTA

Rationale: Non-Puerperal Hyperprolactinemia is another term for Prolactinoma or Lactotroph

adenoma. These terms refer to prolactin-secreting pituitary adenomas.

14. Binds to receptors on the surface of the lactotroph, which diminish intracellular cyclic AMP
(cAMP), consequently decreasing prolactin secretion.
a. TRH
b. VIP
 c. Epidermal Growth Factor
d. Dopamine

Rationale: Dopamine down regulates gene transcription of prolactin proliferation and is

considered to be an inhibitor of prolactin release from the lactotroph cells. TRH, VIP, and EGF
are stimulators of prolactin release.

15. TRUE or ​FALSE​: Reduced clearance provides greater contribution to elevated prolactin
levels than uraemic syndrome

Rationale: Reduced clearance provides a LESSER contribution to elevated prolactin levels.

Direct uraemic toxin effect on hypothalamic function is reducing inhibitory dopaminergic tonus
thereby increasing prolactin secretion.

16. How does Clomipramine increase prolactin levels?

a. An antagonist at dopamine (D2) receptors.
b. Increased GABA activity
c. Indirect effect of serotonin on prolactin release
d. A and C
e. B and C

Rationale: Clomimpramine might be linked to an increased GABA activity or to an indirect effect

of serotonin on prolactin release.

17. How does reserpine increase prolactin levels?

a. Decreases the conversion of L-DOPA to dopamine.
b. Blocks transport of catecholamine into storage granules
c. Prevents the release of catecholamine from the vesicles
d. Increases catecholamine reuptake from the synapse

Rationale: Clomimpramine might be linked to an increased GABA activity or to an indirect effect

of serotonin on prolactin release.

18. First-line approach for damaged hypothalamus-causing hyperprolactinemia

a. pituitary irradiation
b. dopamine agonists (e.g., cabergoline, bromocriptine)
c. transsphenoidal hypophysectomy
d. NOTA

Rationale: Transphenoidal hypophysectomy involves surgical resection of a part of

(hemi-hypophysectomy) or the complete pituitary gland (total hypophysectomy). A microscope
or endoscope is introduced up to the anterior wall of the sphenoid sinus either through the
nostrils or through an incision in the buccal mucosa under the upper lip. The pituitary fossa can
then be accessed via the sphenoid sinus. After the pituitary adenoma is resected, the empty
space is sometimes filled with a small fat graft taken via an incision in the anterior abdominal
wall. Pituitary irradiation is 2​nd​ line.

19. First line treatment for primary hypothyroidism

 a. Thyroxine hormone replacement
b. Thyroidectomy
c. Methimazole
d. Radioactive iodine

Rationale: Levothyroxine is the preferred treatment of choice for most patients with primary
hypothyroidism. The goal in treating primary hypothyroidism is to normalize the serum TSH.
This will normalize the prolactin secretion as well.

20. TRUE or ​FALSE: Answer to the previous question should be provided to patient with
hyperprolactinemia for 3 months only.
Rationale:Thyroxine hormone replacement (should not be <4 months)

21. Prolactin levels of nonpregnant women are higher compared to prolactin levels of pregnant
women.
a. True
b. False
c. Sometimes

Rationale: Normal prolactin levels (nonpregnant 2-29 ng/ml) (pregnant female 10-109ng/ml)

22. Second Generations antipsychotics pose the greatest risk of causing hyperprolactinemia.
a. True
b. False
c. Sometimes

Rationale: First Generations antipsychotics pose the greatest risk of causing

hyperprolactinemia.

23. What is the most common physiological or pathological condition that cause
hyperprolactinemia?
a. Benign tumor of Adrenal Gland
b. Benign tumor of Pituitary Gland
c. Benign tumor of Thyroid Gland
d. Benign tumor of Thymus Gland

Rationale: Benign tumor of Pituitary Gland is the most common physiological or pathological
condition that cause hyperprolactinemia

24. What neurotransmitter is being blocked or antagonized by antipsychotics which leads to

increase in prolactin?
a. Dopamine
b. Epinephrine
c. Norepinephrine
d. Cortisol
Rationale: Dopamine is the neurotransmitter that is being blocked or antagonized by
antipsychotics which leads to increase in prolactin that is why we give dopamine agonists as
firstline treatment.

25. In severe case of primary hypothyroidism what levels are usually increase.
a. T/3 and T/4
b. TRH
c. Prolactin
d. Both B and C
e. Both A and B

Rationale: In severe case of primary hypothyroidism the levels of TRH and Prolactin are usually
increased

26. Antagonism of dopamine lead to an increase of prolactin

a. True
b. False
c. Maybe

Rationale: Antagonism of dopamine lead to an increase of prolactin that is why if being blocked
we give dopamine agonist as firstline treatment. And dopamine is the involved neurotransmiter
in case of hyperprolactinemia.

27. This drug is considered to be Cathecolamine depletors.

Reserpine
Methyldopa
Clomipramine
Imipramine
Rationale: Reserpine is peripheral adrenergic neuron antagonist via depletion of tissue store of
cathecolamines resulting in lower blood pressure and sedative effects.

28. Which of the ff. Statements best describes the function of prolactin.
a. Milk Ejection
b. Milk Production
c. Watery absorption
d. AOTA

Rationale: The primary action of prolactin is to stimulate breast epithelial cell preliferation,
thereby inducing and maintaining milk production

29. Primary hyperthyroidism can cause hyperprolactinemia and galactorrhea

a. True
b. False
c. Sometimes.

Rationale: Primary hypothyroidism can cause hyperprolactinemia and galactorrhea, because

increased levels of thyroid releasing hormone increases secretion of prolactin as well as thyroid
stimulating hormone.
30. In the case presented, what caused the development of the patient hyperprolactinemia
a. Prolactinoma
b. Medication
c. Chronic Renal Failure
d. Hypothalamus or Infundubular Stalk Damage

Rationale: On review of the patient’s medications it was noted that the patient was on
perphenazine and olanzapine for paranoid schizophrenia. It was concluded that patient’s
hyperprolactinemia was due to medications which include antipsycholics.

31. A 31-year-old woman, who has two healthy children, notes that she has had no menstrual
periods for the past 6 months, but she is not pregnant and takes no medications. Within the past
week, she has noted some milk production from her breasts. She has been bothered by
headaches for the past 3 months. After nearly hitting a bus while changing lanes driving her
vehicle, she is concerned with her vision. An optometrist finds her lateral vision to be reduced.
On physical examination she is afebrile and normotensive. Which of the following laboratory test
findings is most likely to be present in this woman?
a. Increased serum cortisol
b. Lack of growth hormone suppression
c. Increased serum alkaline phosphatase
d. Hyperprolactinemia

Rationale: The most common mass lesion of the pituitary in an adult is an adenoma that
secretes prolactin, and this explains the amenorrhea-galactorrhea that she has been
experiencing. A large sellar mass can compress the optic chiasm to produce
bitemporalhemianopsia.

32. What are the Clinical effects of hyperprolactinemia, except

a. Menstrual changes
b. Delayed puberty
c. Gallactorrhea
d. Skin rash

Rationale: Menstrual changes (gnrh inhibition), Delayed puberty (gnrh inhibition), Galactorrhea
(milk production), Decreased libido in men/women

33. What is the normal range of prolactin in men

a. 2 -29 ng/ml
b. 10-109 ng/ml
c. 2 – 18 ng/ml
d. 15 – 30 ng/ml

Rationale: The normal range for male is 2-18 ng/ml

Non-pregnant 2 – 29 ng/ml
Pregnant 10-109 ng/ml

34. Drugs that cause low levels of prolactin, except

 a. A Dopamine
b. B. Ergot alkaloid derivatives
c. C. Levodopa
d. D .Fish oil

Rationale: Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty
acids eicosapentaenoic acid and docosahexaenoic acid, precursors of certain eicosanoids that
are known to reduce inflammation in the body and improve hypertriglyceridemia

35. The most common benign tumor of the pituitary gland is a:

a. Glioma
b. Prolactinoma
c. C Carcinoid tumor
d. Islet tumor

Rationale: Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into
the blood or mechanically by pressing on surrounding tissues. In women, symptoms may
include menstrual irregularities and infertility; in men erectile dysfunction and libido may be
impaired.

36. What are the pharmacologic causes of hyperprolactinemia? Except

a. H2 receptor blockers
b. SSRI
c. Phenothiazines
d. HMG coa reductase inhibitors

Rationale: Antidepressant drugs with serotoninergic activity, including selective serotonin

reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I) and some tricyclics, can
cause hyperprolactinemia.

37. What are the physiologic causes of hyperprolactinemia? Except:

a. Pregnancy
b. Nipple stimulation
c. Phenothiazines
d. Stress

Rationale: There are many etiologies of hyperprolactinemia, including physiologic as well as

pathologic causes. Physiologic causes include pregnancy, lactation, sleep-associated, nipple
stimulation and sexual orgasm, chest wall stimulation, or trauma. Stress is also an important
physiologic cause of hyperprolactinemia

38. What cells secrete prolactin?

a. Lactotrophs
b. Islet cells
c. Acinar cells
d. B cells
Rationale: Prolactin is a single-chain protein hormone closely related to growth hormone. It is
secreted by so-called lactotrophs in the anterior pituitary. It is also synthesized and secreted by
a broad range of other cells in the body, most prominently various immune cells, the brain and
the decidua of the pregnant uterus.

39. What hormone from the hypothalamus stimulates prolactin secretion?

a. Nrh
b. Trh
c. ACTH
d. Crh

Rationale: The thyrotropin-releasing hormone and the vasoactive intestinal peptide stimulate the
secretion of prolactin in experimental settings, however their physiological influence is unclear.
The main stimulus for prolactin secretion is suckling, the effect of which is neuronally mediated.

40. What hormone controls prolactin level?

a. Dopamine, negative control
b. Dopamine, positive control
c. Somastatin
d. Parathyroid hormone

Rationale: Dopamine restrains the production of prolactin, while estrogen increases it.
Dopamine restrains prolactin production, so the more dopamine there is, the less prolactin is
released.

41. It is the hormone that stimulates milk production in the breast.

a. Prolactin
b. Oxytocin
c. Leutinizing hormone
d. a and b

42. Lactation is the secretion of milk by the mammary glands.

a. True
b. False
c. Maybe
d. All of the above

43. It is the most common type of pituitary tumor. It hyper secretes prolactin.
a. Prolactinoma
b. Empty Sella Syndrome
c. Cushing’s Syndrome
d. Craniopharyngioma
Rationale: Prolactinoma are the most common type of pituitary tumor. Symptoms of
prolactinoma are caused by pressure of the tumor on surrounding tissues or by excessive
release of prolactin from the tumor into the blood (causing a condition known as
hyperprolactinemia)

44. High prolactin secretion.

a. Hypoprolactinemia
b. Hyperproctinemia
c. Both a and b
d. None of the above

Rationale: Condition in which a person has higher-than-normal levels of the hormone prolactin
in the blood.

45. Prolactin inhibits which of the following:

a. GnRH secretion
b. FSH
c. LH
d. None of the above

Rationale: Prolactin inhibits secretion of gonadotropin releasing hormone (GnRH) form the
hypothalamus, thereby decreasing the secretion of gonadotropins (luteinizing hormone and
follicle-stimulating hormone) and inhibit the action of gonadortropin of the gonads.

46. Low gonadal function that results from low gonadotropin secretion
a. Hypogonadotropic hypogonadism
b. Idiopathic hypogonadotropic hypogonadism
c. Both a and b
d. None of the above

Rationale: Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a

problem with the pituitary gland or hypothalamus.

47. Abnormal milk production

a. Galactorrhea
b. Pyorrhea
c. Diarrhea
d. Steatorrhea

Rationale: milky nipple discharge unrelated to the normal milk production of breast-feeding.

48. The first line treatment for hyperprolactinemia is usually medical treatment with a:
a. Norepinephrine Agonist
b. Catecholamine Antagonist
c. Dopamine Agonist
d. Serotonin Agonist
49. Two (2) Dopamine Agonists that are approved for the treatment of hyperprolactinemia are:
a. Bromocriptine
b. Carbegoline
c. PDE 5 inhibitor
d. Both a and b

50. A hormone released from the posterior pituitary that causes milk ejection
a. Oxytocin
b. Prolactin
c. None of the above
d. All of the above

Rationale: Oxytocin reflex is also sometimes called the “letdown reflex” or the “milk ejection
relfex”