A 45-year-old woman presents with menstrual irregularity, galactorrhea, and bitemporal hemianopia. MRI shows a 15 mm sellar mass with suprasellar extension. Serum prolactin is 3200 ng/mL. The first-line treatment for this condition is:

• A Trans-sphenoidal surgical resection
• B Radiation therapy to the pituitary
• C Cabergoline (dopamine agonist) ✓
• D Bromocriptine combined with octreotide

Explanation

Prolactinoma (lactotroph adenoma) is the most common functional pituitary adenoma. A prolactin >200 ng/mL with a macroadenoma (>10 mm) showing mass effects is consistent with macroprolactinoma. First-line treatment is a dopamine agonist — cabergoline (preferred over bromocriptine due to superior efficacy and tolerability) — which normalizes prolactin in >80% of patients and shrinks tumor size significantly. Surgery is reserved for dopamine agonist resistance or intolerance, or for vision-threatening rapid progression. This contrasts with GH- and ACTH-secreting adenomas where surgery is first-line.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.