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Microprolactinoma — ABIM Board MCQ

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HardEndocrinology/MetabolismMicroprolactinomaABIM Board

A 31-year-old woman has amenorrhea, galactorrhea, infertility, prolactin 186 ng/mL, normal TSH, and a 7-mm pituitary adenoma without chiasmal compression. She is not taking a prolactin-raising drug. Which initial therapy is preferred?

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Correct answer: E — Begin cabergoline and follow biochemical and imaging response

The best answer is “Begin cabergoline and follow biochemical and imaging response”. A symptomatic microprolactinoma is generally treated first with a dopamine agonist, and cabergoline is preferred because of high efficacy and tolerability. Treatment often restores gonadal function and reduces tumor size, so pregnancy planning and monitoring must be discussed. Surgery is reserved for intolerance, resistance, or selected compressive circumstances; radiation is rarely initial therapy, and observation without follow-up is inappropriate in symptomatic disease.

Reference: Endocrine Society guideline: hyperprolactinemia: https://www.endocrine.org/clinical-practice-guidelines/hyperprolactinemia