Hyperprolactinemia, Prolactinoma: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination–including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Inspection and palpation (palpation) of the thyroid gland.
    • Palpation (palpation) of the abdomen (abdominal) (tenderness?, tapping pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing tapping pain?
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sexual organs).
      • Vagina (vagina)
      • Cervix uteri (cervix), or portio (cervix; transition from the cervix (cervix uteri) to the vagina (vagina)), if necessary, taking a Pap smear (for early detection of cervical cancer).
    • Palpation (bimanual; palpation with both hands) of the internal genital organs:
      • Cervix uteri (cervix).
      • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
      • Adnexa (appendages of the uterus, i.e., the ovary (ovary) and uterine tubule (fallopian tube)) [Normal: free]
      • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
      • Pelvic walls [Normal: free]
      • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear].
    • Inspection of the mammae (breasts), right and left; nipple (breast), right and left; and skin [Normal: unremarkable]; furthermore, note the following: Galactorrhea/diseased breast milk discharge (due to hyperprolactinemia/elevation of blood prolactin levels); classification of galactorrhea:
      • Grade I: only a few drops can be expressed.
      • Grade II: at least 1 ml of liquid expressible
      • Grade III: intermittent spontaneous milk secretion.
      • Grade IV: constant discharge of milk flow.
    • Palpation of the mammae, both supraclavicular pits (upper clavicular pits) and axillae (axillae) [Normal: unremarkable].
  • Urological/andrological examination
    • Inspection and palpation (palpation) of the mammae (mammary glands) [very rarely there is galactorrhea in males; see “Gynecologic Examination” above for classification]
    • Inspection and palpation of the genitals (penis and scrotum; assessment of pubes hair (pubic hair), penis (penis length: between 7-10 cm when flaccid); presence of: Indurations (tissue hardening), anomalies, phimosis / foreskin constriction? as well as the testicular position and size (if necessary by orchimeter); if necessary, the painfulness compared to the opposite side or where is the punctum maximum of pain).
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of the prostate in size, shape and consistency, if necessary, detection of indurations (tissue hardening)).
  • Ophthalmological and neurological examination: if pituitary adenoma is suspected, examination of visual acuity (visual acuity) and oculomotor function (eye movements).
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.