A 32-year-old woman with secondary amenorrhea has prolactin 150 ng/mL (normal <25), TSH normal, no medication use, and normal MRI pituitary. She has galactorrhea. Which management is most appropriate?
- A Transsphenoidal surgery
- B Cabergoline 0.25 mg twice weekly ✓
- C Bromocriptine 1.25 mg daily
- D Repeat prolactin in 3 months
Correct answer: B. Cabergoline 0.25 mg twice weekly
Explanation
Prolactin level >100 ng/mL with amenorrhea and galactorrhea, with normal pituitary MRI (excludes macroprolactinoma), indicates idiopathic hyperprolactinemia or microprolactinoma. Cabergoline is first-line due to better efficacy and tolerability compared to bromocriptine. Surgery is reserved for medication intolerance or macroadenoma with mass effect. Repeat testing is unnecessary with clear symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.