A 24-year-old woman presents with galactorrhea and oligomenorrhea. Serum prolactin is 85 ng/mL (normal <25). TSH is normal. MRI pituitary shows a 6 mm microadenoma. Which is the first-line pharmacotherapy?

• A Bromocriptine (dopamine agonist)
• B Transsphenoidal surgery
• C Levothyroxine
• D Cabergoline (dopamine agonist) ✓

Explanation

Cabergoline is the first-line dopamine agonist for prolactinomas due to better efficacy, twice-weekly dosing, and better tolerability compared to bromocriptine. Both are dopamine agonists, but cabergoline is preferred. Levothyroxine is for hypothyroidism-induced hyperprolactinemia (TSH is normal here). Surgery is reserved for dopamine agonist resistance or intolerance.

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

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