A 34-year-old woman presents with secondary amenorrhoea, galactorrhoea, and a serum prolactin of 186 ng/mL. MRI pituitary shows a 7 mm lesion confined to the sella. She is not planning pregnancy. Which is the most appropriate initial management?

• A Cabergoline ✓
• B Bromocriptine
• C Trans-sphenoidal surgery
• D Observation with repeat MRI in 6 months

Explanation

Cabergoline is the preferred dopamine agonist for microprolactinoma due to its superior efficacy (>80% normalisation of prolactin), once or twice-weekly dosing, better tolerability, and lower rates of resistance compared with bromocriptine. Surgery is reserved for dopamine agonist resistance or intolerance. Observation alone is insufficient given symptomatic disease and bone-density implications of hypo-oestrogenism. Bromocriptine is a valid alternative but inferior tolerability and efficacy make cabergoline first-line.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.