Causes of Prolactinoma
Prolactinoma Causes: Book Excerpts
Prolactinoma as a complication of other conditions:
Other conditions that might have
Prolactinoma as a complication may,
potentially, be an underlying cause of Prolactinoma.
Our database lists the following as having
Prolactinoma as a complication of that condition:
Prolactinoma as a symptom:
Conditions listing Prolactinoma
as a symptom may also be potential underlying causes of Prolactinoma.
Our database lists the following as having
Prolactinoma as a symptom of that condition:
Medications or substances causing Prolactinoma:
The following drugs, medications, substances or toxins are some of the possible
causes of Prolactinoma as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 6
medications causing Prolactinoma
Related information on causes of Prolactinoma:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Prolactinoma may be found in:
Causes of Prolactinoma: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Prolactinoma.
Amenorrhea:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Secondary amenorrhea
-
More common than primary
-
Hypothyroidism
-
Pregnancy
-
Polycystic ovarian syndrome
–Peripubertal onset of menstrual irregularities with hyperandrogenism (hirsutism) and obesity
-
Functional hypothalamic amenorrhea due to stress, eating disorders, weight loss, or excessive exercise
-
Hyperprolactinemia
–Galactorrhea
–Secondary to medications (e.g., OCP,
phenothiazines) or primary due to pituitary adenoma
Primary amenorrhea
-
Constitutional delay of puberty
–Family history of late puberty
–Normal development at later age
-
Outflow tract disorders
–Transverse vaginal septum
–Imperforate hymen
–Pelvic or lower abdominal pain are common presenting symptoms
-
Complete androgen insensitivity syndrome
–X-linked recessive disorder (46,XY)
–Resistance to testosterone due to a defect in the androgen receptor
–Testes may be palpable in labia or inguinal area
-
Müllerian agenesis (Mayer-Rokitansky-Hauser
syndrome)
–Agenesis of fallopian tubes, uterus, vagina
–Normally functioning ovaries
Less common etiologies
-
Turner's syndrome
–45,X gonadal dysgenesis
–Ovaries replaced with fibrous tissue
-
Ovarian failure (autoimmune oophoritis or secondary to chemotherapy or radiation injury)
-
5-αreductase deficiency
-
17-αhydroxylase deficiency
-
Craniopharyngioma
-
Hypopituitarism
-
Congenital GnRH deficiency (Kallman's syndrome if associated with anosmia)
-
Cushing's syndrome
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Amenorrhea – Primary:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Constitutional delay of puberty
–Most common cause
-
Anatomic causes
–Uterine aplasia (Mayer-Rokitansky
syndrome)
–Vaginal aplasia
–Imperforate hymen
-
Hypogonadotropic hypogonadism
–Decreased FSH
–Congenital and acquired etiologies
-
Congenital hypogonadotropic hypogonadism
–Kallmann syndrome
–Panhypopituitarism
-
Aquired hypogonadotropic hypogonadism
–Malnutrition
–Stress
–Anorexia nervosa
–Inflammatory bowel disease
–Celiac disease
–Excessive exercise
–Pituitary tumor (e.g., prolactinoma or
craniopharyngioma)
-
Hypergonadotropic hypogonadism
–Increased FSH
–Gonadal dysgenesis (Turner syndrome is the
most common)
–Ovarian failure: Autoimmune oophoritis, galactosemia, effects of chemotherapy or radiation, FSH or LH receptor mutations (rare)
-
Abnormal thyroid function
-
Androgen insensitivity syndrome
-
Congenital adrenal hyperplasia and other causes of hyperandrogenism
-
Medications
-
Pregnancy
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Amenorrhea – Secondary:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Pregnancy
–Most common cause
-
Anovulatory cycles
–Common during first few years after
menarche
- Hyperandrogenism
–Polycystic ovary syndrome: Problems with fertility are common, LH/FSH ratio is greater than 2.5/1
–Some adrenal tumors
–Congenital adrenal hyperplasia
–Exposure to anabolic steroids
-
Major illness or stress
-
Large changes in weight
–Anorexia nervosa
-
Hypothyroidism
-
Prolactinoma
-
Other causes of hyperprolactinemia
–Marijuana
–Opioids
–Antidepressants
–Phenothiazines
-
Hypothalamic-pituitary failure
–Pituitary tumor
–Sheehan syndrome
–Cranial irradiation
-
Ovarian failure
–Autoimmune destruction
–Infarction due to gonadal torsion
–Chemotherapy or radiation
–Idiopathic
-
Oral contraceptives
–May delay return to regular menses
-
Cushing syndrome
-
Uterine synechiae (Asherman syndrome)
-
Chiari-Frommel syndrome
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Nipple discharge:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Breast abscess
Breast abscess, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include an abrupt onset of a high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer
Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage and vaginal masses.
Intraductal papilloma
Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge — usually from only one duct — is its predominant sign. Discharge may be intermittent or profuse and constant and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With Paget’s disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with prolactin-secreting pituitary tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
Proliferative breast disease is a benign disorder that occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Amenorrhea:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Adrenal tumor. Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.
❑ Adrenocortical hyperplasia. Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.
❑ Adrenocortical hypofunction. In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.
❑ Amenorrhea-lactation disorders. Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.
❑ Anorexia nervosa. Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.
❑ Congenital absence of the ovaries. Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.
❑ Congenital absence of the uterus. Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.
❑ Corpus luteum cysts. Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.
❑ Hypothalamic tumor. In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.
❑ Hypothyroidism. Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.
❑ Mosaicism. Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.
❑ Ovarian insensitivity to gonadotropins. A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.
❑ Pituitary tumor. Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.
❑ Polycystic ovary syndrome. Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Or, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.
❑ Pseudoamenorrhea. An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.
❑ Pseudocyesis. With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.
❑ Testicular feminization. Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.
❑ Thyrotoxicosis. Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.
❑ Turner’s syndrome. Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.
❑ Uterine hypoplasia. Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.
Other causes
❑ Drugs. Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.
❑ Radiation therapy. Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.
❑ Surgery. Surgical removal of both ovaries or the uterus produces amenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Galactorrhea:
Causes
(Professional Guide to Diseases (Eighth Edition))
Galactorrhea usually develops in a person with increased prolactin secretion from the anterior pituitary gland, with possible abnormal patterns of secretion of growth, thyroid, and adrenocorticotropic hormones. However, increased prolactin serum concentration doesn’t always cause galactorrhea.
Additional factors that may precipitate this disorder include the following:
❑ endogenous: pituitary (high incidence with chromophobe adenoma), ovarian, or adrenal tumors and hypothyroidism; in males, pituitary, testicular, or pineal gland tumors
❑ idiopathic: possibly from stress or anxiety, which causes neurogenic depression of the prolactin-inhibiting factor
❑ exogenous: breast stimulation, genital stimulation, or drugs (such as hormonal contraceptives, meprobamate, and phenothiazines).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Amenorrhea:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Amenorrhea is normal before puberty, after menopause, or during pregnancy and lactation; it’s pathologic at any other time. It usually results from anovulation due to hormonal abnormalities, such as decreased secretion of estrogen, gonadotropins, luteinizing hormone, and follicle-stimulating hormone; lack of ovarian response to gonadotropins; or constant presence of progesterone or other endocrine abnormalities.
Amenorrhea may also result from the absence of a uterus, endometrial damage, or from ovarian, adrenal, or pituitary tumors. It’s also linked to emotional disorders and is common in patients with severe disorders, such as depression and anorexia nervosa. Mild emotional disturbances tend merely to distort the ovulatory cycle, while severe psychic trauma may abruptly change the bleeding pattern or may completely suppress one or more full ovulatory cycles. Amenorrhea may also result from malnutrition, intense exercise, and prolonged hormonal contraceptive use. The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some other cause than pregnancy) is about 4%.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Nipple discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Breast abscess
This disorder, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include abrupt onset of high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer
This may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage, and vaginal masses.
Herpes zoster
This virus can stimulate the thoracic nerves, causing bilateral, spontaneous, intermittent galactorrhea. Other characteristics include shooting or burning pain, eruption of small red nodules or vesicles on the thorax and possibly the arms and legs, pruritus and paresthesia or hyperesthesia in affected areas, headache, and fever and malaise.
Hypothyroidism
This disorder occasionally causes galactorrhea. Related findings include bradycardia; weight gain despite anorexia; decreased mentation; periorbital edema; menorrhagia; constipation; puffy face, hands, and feet; brittle, sparse hair; and dry, doughy, pale, cool skin.
Intraductal papilloma
This disorder is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge—usually from only one duct—is its predominant sign. Discharge may be intermittent or profuse and constant, and can often be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of this disorder. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With this disorder, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with this tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
This benign disorder occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Trauma
Bilateral galactorrhea can result from trauma to the breasts.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amenorrhea:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Adrenal tumor
Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.
Adrenocortical hyperplasia
Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism also typically appear.
Adrenocortical hypofunction
Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.
Amenorrhea-lactation disorders
Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.
Anorexia nervosa
Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.
Congenital absence of the ovaries
Congenital absence of the ovaries results in primary amenorrhea and absence of secondary sex characteristics.
Congenital absence of the uterus
Primary amenorrhea occurs with congenital absence of the uterus. The patient also may fail to develop breasts.
Corpus luteum cysts
Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.
Hypothalamic tumor
In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.
Hypothyroidism
Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.
Mosaicism
Mosaicism is a genetic disorder that results in primary amenorrhea and absence of secondary sex characteristics.
Ovarian insensitivity to gonadotropins
Ovarian insensitivity to gonadotropins is a hormonal disturbance that leads to amenorrhea and absence of secondary sex characteristics.
Pituitary infarction
Pituitary infarction usually causes postpartum failure to lactate and to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.
Pituitary tumor
Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, visual disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.
Polycystic ovary syndrome
Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Alternatively, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany polycystic ovary syndrome.
Pseudoamenorrhea
An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.
Pseudocyesis
In pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.
Sertoli-Leydig cell tumor
Sertoli-Leydig cell tumor is an ovarian tumor that may produce amenorrhea along with acne, hirsutism, deepening of the voice, balding, muscle mass development, and clitoral enlargement.
Testicular feminization
Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, exhibits breasts and external genitalia but scant or absent pubic hair.
Thyrotoxicosis
Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.
Turner’s syndrome
Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.
Uterine hypoplasia
Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.
Other causes
Drugs
Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.
Radiation therapy
Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.
Surgery
Surgical removal of both ovaries or the uterus produces amenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Secondary Amenorrhea:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Pregnancy
❑ Menopause
❑ Functional hypothalamic amenorrhea
❑ Drugs
❑ Anorexia nervosa
❑ Post-contraceptive
❑ Endometrial scarring
❑ Endocrinopathy
❑ Hyperprolactinemia
❑ Premature ovarian failure
❑ Polycystic ovary syndrome
❑ Chromophobe adenoma
❑ Ovarian tumors
❑ Panhypopituitarism
❑ Müllerian dysgenesis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Nipple discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Breast abscess
A breast abscess, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or an infected duct. Associated findings include abrupt onset of high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and, possibly, nipple retraction.
Breast cancer
Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from choriocarcinoma, a highly malignant neoplasm that can follow pregnancy. Other characteristics of choriocarcinoma include persistent uterine bleeding and bogginess after delivery or curettage, and vaginal masses.
Herpes zoster
Herpes zoster can stimulate the thoracic nerves, causing bilateral, spontaneous, intermittent galactorrhea. Other characteristics include shooting or burning pain, eruption of small red nodules or vesicles on the thorax and possibly the arms and legs, pruritus and paresthesia or hyperesthesia in affected areas, headache, and fever and malaise.
Intraductal papilloma
Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non-breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge — usually from only one duct — is its predominant sign. Discharge may be intermittent or profuse and constant, and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With Paget’s disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with this tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
Proliferative (fibrocystic) breast disease is a benign disorder that occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Trauma
Bilateral galactorrhea can result from trauma to the breasts. Depending on the cause and severity of the chest trauma, the patient may also have chest pain, dyspnea, bruising, flail chest, cardiac tamponade, pulmonary artery tears, ventricular rupture, shock, and bronchial, tracheal, or esophageal tears or rupture.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Amenorrhea:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Adrenal tumor
In a patient with an adrenal tumor, amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.
Adrenocortical hyperplasia
In a patient with adrenocortical hyperplasia, amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.
Adrenocortical hypofunction
Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.
Anorexia nervosa
Anorexia nervosa, a psychological disorder, can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.
Congenital absence of the ovaries and uterus
Congenital absence of the ovaries and uterus results in primary amenorrhea and absence of secondary sex characteristics. Primary amenorrhea occurs with congenital absence of the uterus. The patient may not develop breasts.
Corpus luteum cysts
Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.
Hypothyroidism
Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.
Pituitary infarction
Pituitary infarction usually causes postpartum failure to lactate and failure to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.
Pituitary tumor
Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, vision disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.
Polycystic ovary syndrome
In polycystic ovary syndrome, menarche typically occurs at a normal age and is followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea or periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.
Pseudoamenorrhea
With pseudoamenorrhea, an anatomic anomaly such as imperforate hymen obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.
Testicular feminization
Primary amenorrhea may signal testicular feminization, a form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.
Thyrotoxicosis
Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.
Turner’s syndrome
Primary amenorrhea and failure to develop secondary sex characteristics may signal Turner’s syndrome, a syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.
Other causes
Drugs
Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.
Radiation therapy
Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.
Surgery
Surgical removal of both ovaries or the uterus produces amenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nipple discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Breast abscess.Breast abscess may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include an abrupt onset of a high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer.Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d'orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma.Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage and vaginal masses.
Intraductal papilloma.Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge—usually from only one duct—is its predominant sign. Discharge may be intermittent or profuse and constant and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia.A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget's disease.With Paget's disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor.Bilateral galactorrhea may occur with prolactin-secreting pituitary tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease.Proliferative breast disease occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Other causes
Drugs.Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (such as reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery.Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Amenorrhea:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Adrenal tumor.Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic personality changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.
Adrenocortical hyperplasia.Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.
Adrenocortical hypofunction.In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.
Amenorrhea-lactation disorders.Amenorrhea-lactationdisorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.
Anorexia nervosa.Anorexia nervosa can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.
Congenital absence of the ovaries.Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.
Congenital absence of the uterus.Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.
Corpus luteum cysts.Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.
Hypothalamic tumor.In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.
Hypothyroidism.Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.
Mosaicism.Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.
Ovarian insensitivity to gonadotropins.A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.
Pituitary tumor.Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.
Polycystic ovary syndrome.Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.
Pseudoamenorrhea.An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.
Pseudocyesis.With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.
Testicular feminization.Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.
Thyrotoxicosis.Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.
Turner's syndrome.Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.
Uterine hypoplasia.Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.
Other causes
Drugs.Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they're discontinued.
Radiation therapy.Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.
Surgery.Surgical removal of both ovaries or the uterus produces amenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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