A 27-year-old woman has secondary amenorrhoea for 6 months with bilateral galactorrhoea. Serum prolactin is 140 ng/mL, TSH is normal, and MRI shows a 7 mm pituitary microadenoma. What is the first-line treatment?

• A Cabergoline ✓
• B Transsphenoidal surgery
• C Bromocriptine
• D Combined oral contraceptive pill

Explanation

Dopamine agonists are first line for hyperprolactinaemic amenorrhoea with a microadenoma. Cabergoline is preferred over bromocriptine because of higher efficacy in normalising prolactin, better tolerability, less nausea, and once or twice weekly dosing. Surgery is reserved for dopamine agonist resistance or intolerance. The combined pill treats symptoms but does not lower prolactin or shrink the adenoma.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.