A 48-year-old woman has secondary amenorrhoea, low FSH, low LH, elevated prolactin of 210 ng/mL, and bitemporal hemianopia. MRI pituitary shows a 1.4 cm macroadenoma. What is the first-line treatment?
- A Transsphenoidal surgery
- B Cabergoline ✓
- C Bromocriptine
- D External beam radiotherapy
Correct answer: B. Cabergoline
Explanation
Dopamine agonists (cabergoline preferred over bromocriptine for better tolerability and efficacy) are the first-line treatment for prolactinomas, including macroadenomas. Cabergoline normalises prolactin in >80% and reduces tumour size in most patients, often reversing visual field defects. Transsphenoidal surgery is reserved for dopamine agonist resistance or intolerance. Cabergoline has better efficacy and is taken twice weekly compared to daily bromocriptine.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.