Diagnostic Tests for Prolactinoma
Prolactinoma: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Prolactinoma
includes:
Prolactinoma Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Prolactinoma:
- Colon & Rectal Cancer: Home Testing
- Thyroid: Home Testing:
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Breast Cancer: Related Home Tests:
- Cancer-Related Home Testing:
Prolactinoma Diagnosis: Book Excerpts
Tests and diagnosis discussion for Prolactinoma:
A doctor will test for prolactin blood levels in
women with unexplained milk secretion (galactorrhea) or irregular menses
or infertility, and in men with impaired sexual function and, in rare
cases, milk secretion. If prolactin is high, a doctor will test thyroid
function and ask first about other conditions and medications known to
raise prolactin secretion. The doctor will also request a magnetic
resonance imaging (MRI), which is the most sensitive test for detecting
pituitary tumors and determining their size. MRI scans may be repeated
periodically to assess tumor progression and the effects of therapy.
Computer Tomography (CT scan) also gives an image of the pituitary, but it
is less sensitive than the MRI.
In addition to assessing the size of the pituitary tumor, doctors also
look for damage to surrounding tissues, and perform tests to assess
whether production of other pituitary hormones is normal. Depending on the
size of the tumor, the doctor may request an eye exam with measurement of
visual fields.
(Source: excerpt from Prolactinoma: NIDDK)
Diagnostic Tests for Prolactinoma: Online Medical Books
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AMENORRHEA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The first thing to do is a pregnancy test, as pregnancy is the most common cause of secondary amenorrhea. If the pregnancy test is negative, referral to a gynecologist may be done at this time. If a specialist is not handy, one may proceed with the workup. A trial of medroxyprogesterone acetate (ProveraŽ) may be done by intermuscular injection or by mouth. If bleeding occurs on withdrawal of the progesterone, then it is established that the uterus is functional. It also establishes that the cervix and vagina are patent. If bleeding does not occur, uterine pathology is likely, and referral to a gynecologist is necessary.
If there is no galactorrhea, a normal response to progesterone, and the patient is a teenager, one may simply discontinue studies at this point and observe for the normal onset of the menstrual cycle.
If the patient with primary amenorrhea has already reached her twenties or if there is definite secondary amenorrhea, then further diagnostic studies should be done. If there is galactorrhea, a serum for prolactin should be done. If that is elevated, a CT scan of the brain should be done to look for a pituitary tumor or hypothalamic tumor. If there is no galactorrhea, one should still order a prolactin, but also order tests for follicle-stimulating hormone (FSH), luteinizing hormone (LH), and serum estradiol. If the FSH and LH are elevated and the estradiol is decreased, primary ovarian failure must be considered. A buccal smear for sex chromogens should be done to rule out Turner's syndrome. Other causes of primary ovarian failure are ovarian agenesis and polycystic ovary syndrome. An elevated free testosterone will support the diagnosis of polycystic ovary syndrome (Stein-Leventhal syndrome).
If the FSH, LH, and estradiol are all decreased, then hypopituitarism should be considered, as well as hypothalamic disorders. Referral to an endocrinologist is wise at this point. When an adrenocortical tumor is suspected, a serum cortisol and cortisol suppression test should be done.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Nipple discharge:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when she first noticed the discharge, and determine its duration, extent, quantity, color, consistency, and smell, if any. Has she had other nipple and breast changes, such as pain, tenderness, itching, warmth, changes in contour, and lumps? If she reports a lump, question her about its onset, location, size, and consistency.
Obtain a complete gynecologic and obstetric history, and determine her normal menstrual cycle and the date of her last period. Ask if she experiences breast swelling and tenderness, bloating, irritability, headaches, abdominal cramping, nausea, or diarrhea before or during menses. Note the number, date, and outcome of her pregnancies and, if she breast-fed, the approximate time of her last lactation. Also, check for risk factors of breast cancer — family history, previous or current malignancies, nulliparity or first pregnancy after age 30, early menarche, or late menopause.
Start your physical examination by characterizing the discharge. If the discharge isn’t frank, try to elicit it. (See Eliciting nipple discharge.) Then examine the nipples and breasts with the patient in four different positions: sitting with her arms at her sides; with her arms overhead; with her hands pressing on her hips; and leaning forward so her breasts are suspended. Check for nipple deviation, flattening, retraction, redness, asymmetry, thickening, excoriation, erosion, or cracking. Inspect her breasts for asymmetry, irregular contours, dimpling, erythema, and peau d’orange. With the patient in a supine position, palpate the breasts and axillae for lumps, giving special attention to the areolae. Note the size, location, delineation, consistency, and mobility of any lump you find.
Is the patient taking hormones (hormonal contraceptives or hormone replacement therapy)? Is the discharge spontaneous, or does it have to be expressed?
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Amenorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last period. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including the number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nipple discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when she first noticed the discharge, and determine its duration, extent, quantity, color, consistency, and smell, if any. Has she had other nipple and breast changes, such as pain, tenderness, itching, warmth, changes in contour, and lumps? If she reports a lump, question her about its onset, location, size, and consistency.
Obtain a complete gynecologic and obstetric history, and determine her normal menstrual cycle and the date of her last menses. Ask if she experiences breast swelling and tenderness, bloating, irritability, headaches, abdominal cramping, nausea, or diarrhea before or during menses. Note the number, date, and outcome of her pregnancies and, if she breast-fed, the approximate time of her last lactation. Also, check for any risk factors of breast cancer—family history, previous or current malignancies, nulliparity or first pregnancy after age 30, early menarche, or late menopause.
Start your physical examination by characterizing the discharge. If the discharge isn’t frank, try to elicit it. (See Eliciting nipple discharge.) Then examine the nipples and breasts with the patient in four different positions: sitting with her arms at her sides; with her arms overhead; and with her hands pressing on her hips; and leaning forward so her breasts are suspended. Check for nipple deviation, flattening, retraction, redness, asymmetry, thickening, excoriation, erosion, or cracking. Inspect her breasts for asymmetry, irregular contours, dimpling, erythema, and peau d’orange. With the patient in a supine position, palpate the breasts and axillae for lumps, giving special attention to the areolae. Note the size, location, delineation, consistency, and mobility of any lump you find.
Is the patient taking hormones (hormonal contraceptives or hormone replacement therapy)? Is the discharge spontaneous, or does it have to be expressed?
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amenorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menstrual cycles. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nipple Discharge:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Clinical breast examination (Chapter 11.2)
1. Inspection. Observe the skin of the breast for crusting or a rash on the nipple or areolar region. Document the color of any discharge. Look for evidence of nipple retraction. Locate the site of the discharge on the nipples. Magnification can assist localization. Look for chest wall scars, evidence of viral infections (e.g., herpes zoster or simplex), and signs of eczema or inflammation.
2. Palpation. Feel the skin surface for warmth in the presence of erythema. Palpate both breasts for evidence of a mass or tenderness. Palpate regional nodes for evidence of lymphadenopathy (Chapters 11.2 and 15.2).
3. Compression. Compress the nipple and areolar area of both breasts with the thumb and index finger in an effort to elicit a discharge. Perform this examination in several directions. Note the location of any discharge and the number of ducts involved, as well as whether the discharge is unilateral or bilateral.
B. Other examination components. Palpate the thyroid and liver if history indicates the need. Perform a neurologic examination, including visual fields, in patients with visual disturbance or headache.
Testing
A. Clinical laboratory. Order blood tests looking for evidence of thyroid, renal, and liver diseases or establishing a prolactin level, based on clinical history.
B. Discharge. Test for occult blood if blood is not readily apparent. The specificity and sensitivity of cytology limits its effectiveness and is not necessary.
C. Imaging. Mammography is indicated to look for nonpalpable masses or calcifications. Ductography may help distinguish the location of ductal pathology in a localized discharge but is not a substitute for exploration of the ductal system.
D. Ductal exploration. The patient who does not have a good physiologic explanation for her discharge should be referred for surgical exploration or biopsy.
Diagnostic assessment (1,2)
A. Categories of risk. The four categories of risk described by Arnold and Neiheisel include lactation, physiologic, pathologic, and false discharge (1).
1. Physiologic discharges are usually bilateral, multiductal, painless, and associated with either stimulation of the nipple or medications. Color may be white, yellow, gray, or green, and the consistency is usually milky. Occasionally, blood is present.
2. Pathologic discharges are usually unilateral, uniductal, and spontaneous. Color is variable and blood or purulence may be apparent. Cancer, benign tumors, infections, and systemic disease are pathologic causes of discharges of this type.
3. Pseudodischarge. A false discharge is often associated with staining on clothing or crusting on the nipple. This is different from the “droplets” of a true discharge. Eczema, viral infections (herpes zoster or simplex), or Paget’s disease can cause a pseudodischarge.
B. Specific disorders of interest
1. Intraductal papilloma is the most common cause of benign pathologic discharges.
2. Ductal ectasia is the result of a progression of ductal stagnation and resultant inflammatory process. The incidence of this disorder is higher in smokers and is most prominent in those aged 40 to 60 years. Induration and noncyclic burning pain are characteristic of this disorder.
3. Paget’s disease involves the skin of the nipple and areola. It is usually associated with ductal carcinoma. Send any areolar lesion that does not respond to antibiotics or topical treatment for biopsy to exclude this disorder.
References
1. Arnold G, Neiheisel M. A comprehensive approach to evaluating nipple discharge. Nurse Pract 1997;22(7):96–108.
2. Andolsek K, Copeland J. Conditions of the breast. In: Taylor RB, ed. Family medicine: principles and practice, 5th ed. New York: Springer-Verlag, 1998.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Amenorrhea:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The purpose of the focused examination is to screen for abnormal anatomy or development and signs of endocrinopathies. A breast examination should document the presence or absence of galactorrhea which, with hair distribution, should provide an evaluation of normal secondary sexual characteristics (Tanner stage). Palpate the thyroid for enlargement or nodules. A careful pelvic examination is essential to detect any structural abnormalities or lesions. Signs of possible androgenic excess are truncal obesity, hirsutism, acne, male pattern baldness, and clitoral enlargement (Chapter 14.3).
Testing
A. Clinical laboratory tests. Serum or urine human chorionic gonodotropin, thyroid-stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone are usually the only tests required to make a diagnosis (section V). Additional tests for premature ovarian failure should include free thyroxine (T4), thyroid antibodies, morning cortisol, calcium, phosphorus and antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, and a complete blood count. Further adrenal evaluation of women who exhibit signs of hyperandrogenism with anovulation (“hyperandrogenic chronic anovulation”) includes fasting serum testosterone, dehydroepiandrosterone (DHEA)-S, and 17-hydroxyprogesterone (17-HP).
B. Other laboratory evaluation. Karotyping is indicated in all women with premature ovarian failure prior to age 30 years or with any physical evidence suggestive of Turner’s syndrome (short stature, web neck, shield-shaped chest, lack of secondary sexual characteristics) (3). Endometrial biopsy should be considered in women with prolonged amenorrhea or with evidence of estrogen or androgen excess to exclude endometrial hyperplasia.
C. Provocative tests
1. Progesterone challenge test. Oral progesterone acetate (10 mg daily for 15 days). A positive test is withdrawal bleeding between days 2 and 7 after finishing medication; alternatively, parenteral progesterone (200 mg) in oil or micronized progesterone 200 mg at bedtime.
2. Estrogen-progesterone challenge test. Oral conjugated estrogen (1.25 mg) or 2 mg estadiol qd for days 1 through 21 with oral progesterone acetate (10 mg) on days 17 through 21. A positive test is withdrawal bleeding between days 2 and 7 after finishing medication.
D. Diagnostic imaging. A coned lateral view of the sella turcica is indicated as a screening examination for galactorrhea if the prolactin level is less than 100 ng/ml. A magnetic resonance imaging scan, which is more sensitive, is indicated for elevated prolactin, abnormal screening x-ray film, or diagnosis of hypothalamic amenorrhea (section V).
Diagnostic assessment
Use the approach outlined in Figure 11.1 to guide diagnosis (1–3).
References
1. Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility, 5th ed. Baltimore: Williams & Wilkins, 1994:401–456.
2. Kiningham RB, Apgar BS, Swenk TL. Evaluation of amenorrhea. Am Fam Physician 1996;53:1185–1194.
3. Scott J, DiSaia P, Hammond C, Spellacy W, eds. Danforth’s obstetrics and gynecology, 7th ed. Philadelphia: JB Lippincott, 1994:665–679.
4. Alper MM, Garner PR. Premature ovarian failure: its relationship to autoimmune disease. Obstet Gynecol 1985;66:27–30.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Secondary Amenorrhea:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Evaluation should always begin with a history and a urine hCG for pregnancy. On physical examination, attention should be paid to darkening of the areola, and evidence of estrogenization of the vagina.
Estrogen sufficiency can be assessed by observing a fern-like pattern of cervical mucous on a slide or by giving medroxyprogesterone for 5 days and looking for withdrawal bleeding. Bleeding suggests suppression of LH surge as seen in functional amenorrhea or polycystic ovary syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Nipple discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Start your physical assessment by characterizing the discharge. If the discharge isn’t frank, try to elicit it. (See Eliciting nipple discharge.) Then examine the nipples and breasts with the patient in four different positions: sitting with her arms at her sides; with her arms overhead; with her hands pressing on her hips; and leaning forward so her breasts are suspended. Check for nipple deviation, flattening, retraction, redness, asymmetry, thickening, excoriation, erosion, or cracking. Inspect her breasts for asymmetry, irregular contours, dimpling, erythema, and peau d’orange. With the patient in a supine position, palpate the breasts and axillae for lumps, giving special attention to the areolae. Note the size, location, delineation, consistency, and mobility of any lump you find.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Amenorrhea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nipple discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when she first noticed the discharge, and determine its duration, extent, quantity, color, consistency, and smell, if any. Is the discharge spontaneous or does it have to be expressed? Has she had other nipple and breast changes, such as pain, tenderness, itching, warmth, changes in contour, and lumps? If she reports a lump, question her about its onset, location, size, and consistency. Ask about other symptoms, such as fever and malaise.
Obtain a complete gynecologic and obstetric history, and determine her normal menstrual cycle and the date of her last menses. Ask if she experiences breast swelling and tenderness, bloating, irritability, headaches, abdominal cramping, nausea, or diarrhea before or during menses. Note the number, date, and outcome of her pregnancies and, if she breast-fed, the approximate time of her last lactation. Also, check for risk factors of breast cancer—family history, previous or current malignancies, nulliparity or first pregnancy after age 30, early menarche, or late menopause.
Is the patient taking hormones (such as hormonal contraceptives or hormone replacement therapy), antihypertensives, or psychotropic drugs?
Start your physical examination by characterizing the discharge. If the discharge isn't frank, try to elicit it. (See Eliciting nipple discharge.) Then examine the nipples and breasts with the patient in four different positions: sitting with her arms at her sides; with her arms overhead; with her hands pressing on her hips; and leaning forward so her breasts are suspended. Check for nipple deviation, flattening, retraction, redness, asymmetry, thickening, excoriation, erosion, or cracking. Inspect her breasts for asymmetry, irregular contours, dimpling, erythema, and peau d'orange. With the patient in a supine position, palpate the breasts and axillae for lumps, giving special attention to the areolae. Note the size, location, delineation, consistency, and mobility of any lump you find.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Amenorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by determining whether the amenorrhea is primary or secondary. If it's primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient's physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient's previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Ask about the patient's eating habits, including the number and size of daily meals and snacks, and ask if she has gained or lost weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you're responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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