A 28-year-old woman presents with secondary amenorrhea, galactorrhea, and headache. MRI shows a pituitary lesion measuring 14 mm. Prolactin is 3200 mIU/L. Which statement about management is MOST accurate?
- A Transsphenoidal surgery is first-line treatment
- B Dopamine agonists are contraindicated if she wishes to conceive
- C Cabergoline is preferred over bromocriptine due to higher efficacy and better tolerability ✓
- D Radiotherapy should be initiated if tumor size exceeds 10 mm
Correct answer: C. Cabergoline is preferred over bromocriptine due to higher efficacy and better tolerability
Explanation
Cabergoline (a D2-receptor agonist with long half-life) is the preferred first-line treatment for prolactinomas because it normalizes prolactin in >80–90% of cases, achieves tumor shrinkage, and is better tolerated than bromocriptine. Surgery is reserved for resistant or intolerant cases or apoplexy. Dopamine agonists can be used in women wanting pregnancy and are often tapered once pregnancy is achieved. Radiotherapy is a last-resort option.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.