A 26-year-old woman presents with secondary amenorrhoea, galactorrhoea, and a serum prolactin of 180 µg/L. MRI shows a 9 mm pituitary lesion. Which statement best describes the initial management according to current Endocrine Society guidelines?
- A Cabergoline is the preferred first-line dopamine agonist due to greater efficacy and better tolerability ✓
- B Bromocriptine is preferred over cabergoline as first-line because of longer safety data in pregnancy
- C Transsphenoidal surgery is the treatment of choice for all microadenomas
- D Combined oral contraceptive pill with observation is adequate initial management
Correct answer: A. Cabergoline is the preferred first-line dopamine agonist due to greater efficacy and better tolerability
Explanation
Current Endocrine Society guidelines recommend cabergoline as the first-line dopamine agonist for prolactinomas due to superior tumour shrinkage rates (~80%), higher probability of prolactin normalisation, once or twice weekly dosing, and better tolerability compared to bromocriptine. Bromocriptine is preferred only if pregnancy is planned soon, given its established safety record in early pregnancy. Surgery is reserved for resistance or intolerance to dopamine agonists. COCPs alone do not address tumour growth.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.