Microprolactinoma — SCE Endocrinology MCQ

Correct answer: E — Cabergoline with prolactin and tumour-size monitoring

The best answer is “Cabergoline with prolactin and tumour-size monitoring”. A symptomatic microprolactinoma is usually treated first-line with a dopamine agonist; cabergoline has high biochemical and tumour-response efficacy and is generally well tolerated. “Offer trans-sphenoidal surgery routinely before a dopamine agonist trial” is less appropriate because surgery is an alternative for selected preference, intolerance or resistance scenarios rather than the routine first step “Use pituitary radiotherapy to prevent future enlargement” is less appropriate because radiotherapy is disproportionate for a small treatment-responsive adenoma “Give oestrogen alone without treating hyperprolactinaemia” is less appropriate because oestrogen does not address tumour secretion and can mask continuing hypogonadism “Observe without treatment despite symptomatic hypogonadism” is less appropriate because ongoing amenorrhoea and galactorrhoea provide a clear reason to treat

Reference: Pituitary Society international consensus statement on prolactinoma. https://www.nature.com/articles/s41574-023-00886-5