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Macroprolactinoma — SCE Endocrinology MCQ

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ModeratePituitaryMacroprolactinomaSCE Endocrinology

A 28-year-old woman presents with amenorrhoea, galactorrhoea and headaches. Prolactin is 86,000 mU/L and MRI shows a 16 mm pituitary macroadenoma elevating but not compressing the optic chiasm. Pregnancy test is negative and visual fields are full. What is the most appropriate management?

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Correct answer: C — Start cabergoline with endocrine follow-up

Very high prolactin with a pituitary macroadenoma is a macroprolactinoma, and dopamine agonist therapy is first-line if there is no acute visual emergency. Surgery is usually reserved for intolerance, resistance or urgent decompression scenarios. The pearl is that prolactin level helps distinguish prolactinoma from stalk effect.

Reference: Endocrine Society hyperprolactinaemia guideline, BNF