Macroprolactinoma — RACP Adult Medicine MCQ
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Correct answer: B — Cabergoline
Macroprolactinomas (even with visual field compromise) should be treated with a dopamine agonist (cabergoline preferred over bromocriptine – more effective with fewer side effects) as first-line therapy. Cabergoline dramatically reduces prolactin levels and tumour size in >90% of cases, often restoring visual fields within days to weeks. Surgery is reserved for resistance to or intolerance of dopamine agonists, or pituitary apoplexy.
Reference: eTG – 2025 – Endocrinology; Endocrine Society – 2011 – Prolactinoma Guidelines