ACTIVITY NUMBER:  RES008

ACTIVITY TITLE: Galactorrhea/Hyperprolactinemia

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  October 1, 2012

Reviewed and Updated in 2015

Reviewed and Updated in 2018

Expiration Date: October 1, 2021

Under Review July 2022

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Galactorrhea is a sign of elevated prolactin levels that are increased by both physiologic and pathologic dopamine-suppression mechanisms. Galactorrhea frequently, but not consistently, occurs with hyperprolactinemia. Galactorrhea requires the presence of estrogen and progesterone, and occurs in premenopausal women, and may be associated with mastalgia. Physiologic galactorrhea may persist up to one year post-lactation. This educational module describes the causes of galactorrhea /hyperprolactinemia, and discusses the importance of history and physical, diagnostic studies, while providing treatment options and surgical options for treatment of pituitary adenoma as well as long-term follow-up recommendations.

This educational activity addresses the appropriate terminology of AUB, and identifies methods for patient communication and assessment to determine causal mechanisms and successfully treat this condition.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.      Describe the causes of galactorrhea/hyperprolactinemia.

2.      Elicit a pertinent history to evaluate galactorrhea/hyperprolactinemia.

3.      List the components of a targeted physical examination to evaluate galactorrhea/hyperprolactinemia.

4.      Order and interpret selected diagnostic studies.

5.      Describe treatments for galactorrhea/hyperprolactinemia.

6.      Describe the indications for referral to a neurosurgeon for surgical treatment of a pituitary adenoma.

7.      Describe long-term follow-up for the patient with galactorrhea / hyperprolactinemia /pituitary adenoma, focusing particularly on the risk of complications.

8.      Describe the management of patients with a pituitary adenoma in pregnancy.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD – Nothing to Disclose

Richard H. Reindollar, MD – Nothing to Disclose

DISCLOSURES FOR FACULTY

Ruben J.  Alvero, MD – Nothing to Disclose

Paula Amato, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Helen Kim, MD – Nothing to Disclose

Erica Johnstone, MD – Nothing to Disclose

Emily Jungheim, MD – Consultant for Abbvie, Genentech, Spectrum, Celgene

Lawrence C. Layman, MD – Nothing to Disclose

Richard Legro, MD – Consultant:  Euroscreen; Astra Zeneca; Takeda; Clarus Therapeutics; Grant/Research: Astra Zeneca, Ferring

Meredith Loveless, MD – Nothing to Disclose

Elizabeth McGee, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Robert W. Rebar, MD – Nothing to Disclose

Nanette Santoro, MD  – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Cynthia Sites, MD – Nothing to Disclose

Anne Steiner, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc – Consultant for NoraTherapeutics

Michael Thomas, MD – Consultant: Teva

Kim L. Thornton, MD – Consultant for Parexel

Kimberly Thornton, MD – Nothing to Disclose

Lynn Westphal, MD – Nothing to Disclose

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.