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Macroprolactinoma — SCE Endocrinology MCQ

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HardPituitaryMacroprolactinomaSCE Endocrinology

A 31-year-old woman has prolactin 95,000 mIU/L and a 28 mm macroprolactinoma touching the optic chiasm. She has a stable bitemporal field defect but no apoplexy. What is the preferred initial plan?

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Correct answer: C — Cabergoline with early prolactin and visual-field reassessment

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

E is correct. Cabergoline is first-line for most macroprolactinomas, including many with visual-field impairment, because prolactin falls and tumour size often improves rapidly. Early formal field assessment and prolactin monitoring are essential; MRI timing follows clinical response. Surgery is reserved for acute threat, apoplexy, intolerance or resistance, while radiotherapy is later-line. Observation and oestrogen alone leave mass effect untreated.

Reference: https://www.endocrinology.org/media/kbkh43s3/consensus-guideline-part-2-nature-reviews-endocrinology-2024.pdf