A 32-year-old woman presents with amenorrhea for 6 months and bilateral galactorrhea. Serum prolactin is 148 ng/mL. TSH, free T4, and beta-hCG are normal. MRI reveals a 6 mm pituitary lesion. Which is the most appropriate first-line treatment?
- A Transsphenoidal surgical resection
- B Bromocriptine
- C Cabergoline ✓
- D Radiation therapy
Correct answer: C. Cabergoline
Explanation
Dopamine agonists are first-line for prolactinomas, normalizing prolactin and shrinking tumors in most cases. Cabergoline is preferred over bromocriptine due to better efficacy, tolerability, and twice-weekly dosing. Surgery is reserved for dopamine agonist resistance, intolerance, or macroprolactinomas with compressive symptoms unresponsive to medical therapy. Radiation is third-line.
Reference: Williams Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.