A 30-year-old woman is evaluated for secondary amenorrhea and galactorrhea. MRI pituitary shows a 7 mm microadenoma. Serum prolactin is 142 ng/mL. She has no desire for pregnancy. What is the first-line treatment?

• A Transsphenoidal surgery
• B Bromocriptine
• C Observation and annual MRI
• D Cabergoline ✓

Explanation

Cabergoline is the preferred first-line dopamine agonist for prolactinomas due to its superior efficacy (normalization of prolactin in >80% of microadenomas), better tolerability, once or twice weekly dosing, and lower rate of nausea compared to bromocriptine. Both are dopamine D2 receptor agonists that suppress prolactin secretion and reduce tumor size. Transsphenoidal surgery is reserved for dopamine agonist resistance or intolerance.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.