A 32-year-old woman presents with amenorrhoea, galactorrhoea, and infertility for 8 months. Serum prolactin is 240 ng/mL. MRI shows a 1.2 cm pituitary microadenoma confined to the sella. There is no visual field defect. What is the first-line treatment?

• A Transsphenoidal surgical resection
• B Conventional fractionated radiotherapy
• C Dopamine agonist therapy (cabergoline) ✓
• D Temozolomide chemotherapy

Explanation

Prolactinomas are the only pituitary adenomas where medical therapy is first-line. Dopamine agonists (cabergoline preferred over bromocriptine for efficacy and tolerability) normalize prolactin, restore gonadal function, and shrink tumor in most patients. Surgery is reserved for dopamine agonist resistance or intolerance. Radiotherapy and temozolomide are used for aggressive refractory tumors, not first-line (Williams Endocrinology, 14th ed.).

Reference: Williams Textbook of Endocrinology, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.