A 31-year-old woman presents with headache, visual field defect (bitemporal hemianopsia), galactorrhea, and amenorrhea. MRI shows a 14 mm pituitary adenoma with suprasellar extension. Serum prolactin is 4800 ng/mL. What is the FIRST-LINE treatment?

• A Cabergoline (dopamine agonist) ✓
• B Transsphenoidal surgery
• C External beam radiotherapy
• D Bromocriptine

Explanation

Macroprolactinomas (>10 mm), even with visual field compromise, are treated first-line with dopamine agonists (cabergoline preferred over bromocriptine due to better tolerability and efficacy). Cabergoline normalizes prolactin in >80% and shrinks tumor in most cases, often relieving visual field defects. Surgery is reserved for dopamine agonist failure or apoplexy. Radiotherapy is tertiary. Bromocriptine is effective but less preferred due to higher side-effect burden.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.