|
|
| Line 435: |
Line 435: |
| * Exudate - SAAG < 1.1 g/dL (indicates the ascites is due to non-portal hypertension etiology). | | * Exudate - SAAG < 1.1 g/dL (indicates the ascites is due to non-portal hypertension etiology). |
| ===Less common differentials=== | | ===Less common differentials=== |
| Cirrhosis should also be differentiated from other causes of [[hyperprolactinemia]] that may present as [[galactorrhea]], [[amenorrhea]], (in females) and [[infertility]] (in both males and females) including:
| |
| *'''Physiological:'''
| |
| **Normal [[pregnancy]]<ref name="pmid910825">{{cite journal| author=Rigg LA, Lein A, Yen SS| title=Pattern of increase in circulating prolactin levels during human gestation. | journal=Am J Obstet Gynecol | year= 1977 | volume= 129 | issue= 4 | pages= 454-6 | pmid=910825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=910825 }} </ref>
| |
| *'''Pathological:'''
| |
| **[[Pituitary tumors]] (other than [[prolactinoma]]):<ref name="pmid15316045">{{cite journal| author=Levy A| title=Pituitary disease: presentation, diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 3 | issue= | pages= iii47-52 | pmid=15316045 | doi=10.1136/jnnp.2004.045740 | pmc=1765669 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15316045 }} </ref>
| |
| ***[[Somatotroph adenoma]]: [[Acromegaly]]
| |
| ***[[ACTH-secreting tumor|Corticotroph adenoma]]: [[Cushing's syndrome]]
| |
| **[[Suprasellar tumors]] ([[tumors]] present in the region of the [[pituitary stalk]])
| |
| **[[Hypothyroidism]]<ref name="pmid4199418">{{cite journal| author=Snyder PJ, Jacobs LS, Utiger RD, Daughaday WH| title=Thyroid hormone inhibition of the prolactin response to thyrotropin-releasing hormone. | journal=J Clin Invest | year= 1973 | volume= 52 | issue= 9 | pages= 2324-9 | pmid=4199418 | doi=10.1172/JCI107421 | pmc=333037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4199418 }} </ref>
| |
| **[[Chronic renal failure]]<ref name="pmid7372775">{{cite journal| author=Sievertsen GD, Lim VS, Nakawatase C, Frohman LA| title=Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure. | journal=J Clin Endocrinol Metab | year= 1980 | volume= 50 | issue= 5 | pages= 846-52 | pmid=7372775 | doi=10.1210/jcem-50-5-846 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7372775 }} </ref>
| |
| **[[Hepato-biliary diseases|Liver disease]]<ref name="pmid26958514">{{cite journal| author=Jha SK, Kannan S| title=Serum prolactin in patients with liver disease in comparison with healthy adults: A preliminary cross-sectional study. | journal=Int J Appl Basic Med Res | year= 2016 | volume= 6 | issue= 1 | pages= 8-10 | pmid=26958514 | doi=10.4103/2229-516X.173984 | pmc=4765284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26958514 }} </ref>
| |
| ***[[Cirrhosis]] (with or without [[encephalopathy]])
| |
| ***[[Viral hepatitis]] (with [[encephalopathy]])
| |
| **[[Seizure|Seizure disorder]]<ref name="Ben-Menachem2006">{{cite journal|last1=Ben-Menachem|first1=Elinor|title=Is Prolactin a Clinically Useful Measure of Epilepsy?|journal=Epilepsy Currents|volume=6|issue=3|year=2006|pages=78–79|issn=1535-7597|doi=10.1111/j.1535-7511.2006.00104.x}}</ref><ref name="pmid737437">{{cite journal| author=Trimble MR| title=Serum prolactin in epilepsy and hysteria. | journal=Br Med J | year= 1978 | volume= 2 | issue= 6153 | pages= 1682 | pmid=737437 | doi= | pmc=1608938 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=737437 }} </ref>
| |
| *'''Medication-induced:'''
| |
| **[[Antipsychotic]] medications:<ref name="pmid11048906">{{cite journal| author=David SR, Taylor CC, Kinon BJ, Breier A| title=The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. | journal=Clin Ther | year= 2000 | volume= 22 | issue= 9 | pages= 1085-96 | pmid=11048906 | doi=10.1016/S0149-2918(00)80086-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11048906 }} </ref>
| |
| ***[[Haloperidol]]
| |
| ***[[Risperidone]]
| |
| **[[Antiemetic]] medications:
| |
| ***[[Metoclopramide]]<ref name="pmid777023">{{cite journal| author=McCallum RW, Sowers JR, Hershman JM, Sturdevant RA| title=Metoclopramide stimulates prolactin secretion in man. | journal=J Clin Endocrinol Metab | year= 1976 | volume= 42 | issue= 6 | pages= 1148-52 | pmid=777023 | doi=10.1210/jcem-42-6-1148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=777023 }} </ref>
| |
| ***[[Domperidone]]<ref name="pmid7037817">{{cite journal| author=Sowers JR, Sharp B, McCallum RW| title=Effect of domperidone, an extracerebral inhibitor of dopamine receptors, on thyrotropin, prolactin, renin, aldosterone, and 18-hydroxycorticosterone secretion in man. | journal=J Clin Endocrinol Metab | year= 1982 | volume= 54 | issue= 4 | pages= 869-71 | pmid=7037817 | doi=10.1210/jcem-54-4-869 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7037817 }} </ref>
| |
| **[[Antihypertensive]] medications:
| |
| ***[[Methyldopa]]<ref name="pmid1268617">{{cite journal| author=Steiner J, Cassar J, Mashiter K, Dawes I, Fraser TR, Breckenridge A| title=Effects of methyldopa on prolactin and growth hormone. | journal=Br Med J | year= 1976 | volume= 1 | issue= 6019 | pages= 1186-8 | pmid=1268617 | doi= | pmc=1639736 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1268617 }} </ref>
| |
| ***[[Verapamil]]<ref name="pmid6682619">{{cite journal| author=Fearrington EL, Rand CH, Rose JD| title=Hyperprolactinemia-galactorrhea induced by verapamil. | journal=Am J Cardiol | year= 1983 | volume= 51 | issue= 8 | pages= 1466-7 | pmid=6682619 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6682619 }} </ref>
| |
| {| class="wikitable"
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical Findings
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory findings
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Management
| |
| |-
| |
| |[[Somatotroph adenoma]]:
| |
| [[Acromegaly]]
| |
| |Clinical features of [[acromegaly]] are due to high level of [[Growth hormone|human growth hormone]] ([[Growth hormone|hGH]]):
| |
| * [[Soft tissue]] [[swelling]] of the hands and feet
| |
|
| |
|
| * Brow and lower jaw protrusion
| |
| * Enlarged hands
| |
| * Enlarged feet
| |
| * [[Arthritis]] and [[carpal tunnel syndrome]]
| |
| * Increase in teeth spacing
| |
| * [[Macroglossia]] (enlarged tongue)
| |
| * [[Heart failure]]
| |
| * [[Kidney failure]]
| |
| * Compression of the [[optic chiasm]] leading to loss of [[vision]] in the outer [[visual fields]] (typically [[bitemporal hemianopia]])
| |
| * [[Headache]]
| |
| * [[Diabetes mellitus]]
| |
| * [[Hypertension]]
| |
| * [[Cardiomegaly]]
| |
| |
| |
| * Elevated [[insulin-like growth factor-1]] ([[Insulin-like growth factor-I|IGF-1]]) levels
| |
| * Elevated [[growth hormone]] levels
| |
| |
| |
| * Medical management:
| |
| ** [[Octreotide]]
| |
| ** [[Bromocriptine]]
| |
|
| |
| * Surgical management:
| |
| ** Endonasal transsphenoidal surgery
| |
| * [[Radiation therapy]]
| |
| |-
| |
| |[[ACTH-secreting tumor|Corticotroph adenoma]]: [[Cushing's syndrome]]
| |
| |Clinical features of [[Cushing's syndrome]] are due to increased levels of [[cortisol]]:
| |
| * Rapid [[Obesity|weight gain]], particularly of the [[trunk]] and face with sparing of the [[limbs]] ([[central obesity]])
| |
| * Proximal [[muscle weakness]]
| |
| * A round face often referred to as a "[[moon face]]"
| |
| * Excess [[sweating]]
| |
| * [[Headache]]
| |
| * The excess [[cortisol]] may also affect other endocrine systems and cause, for example:
| |
| ** [[Insomnia]]
| |
| ** Reduced [[libido]]
| |
| ** [[Impotence]]
| |
| ** [[Amenorrhea]]
| |
| ** [[Infertility]]
| |
| * Patients frequently suffer various [[psychological]] disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[Clinical depression|Depression]] and [[anxiety]] are also common.
| |
| |
| |
| * [[Dexamethasone suppression test]]
| |
| * 24 hour urinary measurement of [[cortisol]]
| |
| |
| |
| * Medical management:
| |
| ** [[Pasireotide]]
| |
| ** [[Cabergoline]]
| |
| ** [[Ketoconazole]]
| |
| ** [[Metyrapone]]
| |
| ** [[Mitotane]]
| |
| ** [[Mifepristone]]
| |
| * Surgical management:
| |
| ** Transsphenoidal [[Pituitary gland|pituitary]] resection
| |
| |-
| |
| |[[Hypothyroidism]]
| |
| |Clinical features of [[hypothyroidism]] are due to deficiency of [[thyroxine]]:
| |
| * [[Fatigue]]
| |
|
| |
| * Cold intolerance
| |
| * Decreased [[sweating]]
| |
| * [[Hypothermia]]
| |
| * Coarse [[skin]]
| |
| * [[Weight gain]]
| |
| * [[Hoarseness]]
| |
| * [[Goiter]]
| |
|
| |
| * Fullness in the throat and neck
| |
|
| |
| * [[Depression]]
| |
|
| |
| * [[Emotional lability]]
| |
| * [[Attention deficit]]
| |
| |
| |
| * Elevated [[Thyroid-stimulating hormone|TSH]]
| |
| * Low [[Thyroxine|T4]]
| |
| * Low [[Triiodothyronine|T3]]
| |
| * Elevated anti-thyroid [[antibodies]](anti-TPO)
| |
| |[[Levothyroxine]]
| |
| |-
| |
| |[[Chronic renal failure]]
| |
| |There are no [[pathognomonic]] symptoms associated with [[chronic renal failure]]. Common non-specific symptoms of [[chronic renal failure]] include:
| |
| * [[Malaise]]
| |
| * [[Nausea]]
| |
| * Unintentional [[weight loss]]
| |
| * [[Pruritus]]
| |
| * [[Lower extremity edema]]
| |
| * [[Sleep disorders]]
| |
| |[[Urinalysis]]:
| |
| * [[Albuminuria]]
| |
|
| |
| * [[Hematuria]]
| |
| * [[Pyuria]]
| |
| * [[Red blood cell|Red cell]] or [[White blood cells|white cell]] [[casts]] and crystals
| |
| [[Fluid and electrolytes|Fluid and electrolyte]] disturbances:
| |
| * [[Hyponatremia]]
| |
| * [[Hyperkalemia]]
| |
| * [[Hyperphosphatemia]]
| |
| * [[Hyperchloremia]]
| |
| * [[Metabolic acidosis]]
| |
| * [[Hypocalcemia]]
| |
| [[Endocrine system|Endocrine]] and [[metabolic]] disturbances:
| |
| * [[Hyperuricemia]]
| |
| * [[Hypertriglyceridemia]]
| |
| * Decreased [[HDL]] levels
| |
| * [[Vitamin D deficiency]]
| |
| * Increased [[Parathyroid hormone]] levels
| |
| [[Hematologic]] abnormalities:
| |
| * [[Normocytic normochromic anemia]]
| |
| * [[Lymphocytopenia]]
| |
| * [[Leukopenia]]
| |
| * [[Thrombocytopenia]]
| |
|
| |
| |
| |
| * Medical management:
| |
| ** [[Blood pressure medication|Blood pressure management]]
| |
| ** Control of [[Blood sugar|blood glucose]]
| |
| ** [[Protein]] restriction
| |
| ** Management of [[anemia]]
| |
| ** Management of [[electrolyte disturbance]]
| |
| ** [[Dialysis]]
| |
| * Surgical management
| |
| ** [[Kidney transplant]]
| |
| |-
| |
| |[[Cirrhosis|Liver disease: Cirrhosis]]
| |
| |The clinical features of liver [[cirrhosis]] are very nonspecific. These include:
| |
| * [[Right upper quadrant (abdomen)|Right upper quadrant]] [[abdominal pain]]
| |
| * [[Fever]]
| |
| * [[Fatigue]] and [[weakness]]
| |
| * [[Loss of appetite]]
| |
| * [[Diarrhea]]
| |
| * [[Nausea]] and [[vomiting]]
| |
| * [[Weight loss]]
| |
| * [[Abdominal pain]] and [[bloating]] when fluid accumulates in the [[abdomen]]
| |
| * [[Itching]]
| |
| * [[Menstrual cycle|Menstrual]] irregularities
| |
| |
| |
| *Elevated [[aminotransferases]] ([[Aspartate transaminase|AST]] & [[Alanine transaminase|ALT]])
| |
| *Elevated [[alkaline phosphatase]] ([[Alkaline phosphatase|ALP]])
| |
|
| |
| *Elevated [[gamma-glutamyl transpeptidase]]
| |
|
| |
| *Elevated [[bilirubin]]
| |
|
| |
| *Low [[albumin]]
| |
|
| |
| *Elevated [[prothrombin time]]
| |
|
| |
| *Elevated [[globulin]]
| |
|
| |
| *[[Hyponatremia]]
| |
|
| |
| *[[Anemia]]
| |
|
| |
| *[[Leukopenia]] and [[neutropenia]]
| |
|
| |
| *[[Thrombocytopenia]]
| |
|
| |
| |
| |
| * Medical management:
| |
| ** Treatment is usually directed towards the treatment of complications like [[ascites]], [[esophageal varices]], [[hepatic encephalopathy]], [[hepatorenal syndrome]], and [[spontaneous bacterial peritonitis]].
| |
| *** Some chronic constitutional [[symptoms]] that should be treated include:
| |
| **** [[Pruritis]]: [[Cholestyramine]] is the drug of choice
| |
| **** [[Hypogonadism]]: Topical [[testosterone]] preparations
| |
| **** [[Osteoporosis]]: [[Calcium]] and [[vitamin D]]
| |
| **** Pain management: [[Non-steroidal anti-inflammatory drug|NSAIDS]], [[celecoxib]], [[opioids]]
| |
| **** Nutrition: Adequate [[Calories|caloric]] and [[protein]] intake, and [[multivitamin]] supplementation
| |
| * Surgical management: [[Liver transplantation]]
| |
| |-
| |
| |[[Seizure|Seizure disorder]]
| |
| |The clinical features of [[seizure disorder]] may include:
| |
| * Change in [[alertness]], orientation and time perception
| |
|
| |
| * Mood changes, such as unexplainable fear, panic, joy, or laughter
| |
| * Changes in sensation of the [[skin]], usually spreading over the [[arm]], [[Leg (anatomy)|leg]], or [[trunk]]
| |
| * [[Vision]] changes, including seeing flashing lights
| |
| * Rarely, [[Hallucination|hallucinations]] (seeing things that aren't there)
| |
| * Falling, loss of [[muscle]] control, occurs very suddenly
| |
| * [[Muscle twitching]] that may spread up or down an [[arm]] or [[leg]]
| |
| * [[Muscle]] tension or tightening that causes twisting of the body, [[head]], [[Arm|arms]], or [[legs]]
| |
| * Shaking of the entire body
| |
| * Tasting a bitter or metallic flavor
| |
| |[[Electroencephalogram]]
| |
| |
| |
| * Medical management:
| |
| ** [[Antiepileptics|Antiepileptic]] medications
| |
| |-
| |
| |[[Medication-induced]]
| |
| |Clinical features of [[hyperprolactinemia]] after a specific period of regular medication ingestion
| |
| |Discontinuation of the medication for 3 days and remeasurement of [[prolactin]] levels<ref name="pmid21296991">{{cite journal| author=Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA et al.| title=Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 2 | pages= 273-88 | pmid=21296991 | doi=10.1210/jc.2010-1692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21296991 }}</ref>
| |
| |Change to alternate medication
| |
| |}
| |
|
| |
|
| ==References== | | ==References== |