A 28-year-old woman presents with secondary amenorrhoea, galactorrhoea, and a serum prolactin of 180 ng/mL. MRI pituitary reveals a 12 mm macroadenoma. She wishes to preserve fertility. What is the first-line management?
- A Cabergoline, a dopamine agonist, as first-line therapy ✓
- B Trans-sphenoidal surgery as first line for macroadenoma regardless of fertility wishes
- C Bromocriptine followed by surgery if prolactin does not normalise within 4 weeks
- D Radiotherapy to prevent further tumour growth
Correct answer: A. Cabergoline, a dopamine agonist, as first-line therapy
Explanation
Dopamine agonists — cabergoline preferred over bromocriptine due to superior tolerability and efficacy — are first-line for prolactinomas including macroadenomas, even when fertility is desired. Cabergoline normalises prolactin and reduces tumour size in over 80% of cases. Surgery is reserved for dopamine agonist resistance, intolerance, or CSF leak.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.