A 55-year-old man with a 2 cm pituitary macroadenoma has bitemporal hemianopia and serum prolactin of 320 ng/mL. The MOST appropriate initial management is:

• A Trans-sphenoidal surgery as the visual field defect mandates immediate decompression
• B Cabergoline (dopamine agonist) as first-line therapy ✓
• C External beam radiotherapy to shrink the tumour
• D Bromocriptine plus hydrocortisone replacement

Explanation

Prolactinomas, even giant ones causing visual compromise, respond dramatically to dopamine agonists (cabergoline preferred over bromocriptine for better tolerability and efficacy). Cabergoline reduces tumour size and restores vision in the majority within weeks, making it first-line even when visual fields are affected. Surgery is reserved for dopamine agonist failure or intolerance. Radiotherapy is a last resort.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.