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Question: A 21-year-old female presents with a six-month history of irregular menses, decreased libido, impaired vision, and galactorrhea. An MRI is completed. Based on this imaging and the patient’s clinical findings, which of the following should be recommended as a first-line treatment?

a) Radiation therapy

b) Dopamine agonist

c) Surgical consultation

d) Dopamine antagonist

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Details: This patient has clinical findings and imaging suggestive of macroprolactinoma, a benign adenoma of the pituitary gland that overproduces the hormone prolactin. Dopamine agonists such as cabergoline or bromocriptine are recommended as initial therapy to decrease the production of prolactin, reduce the size of the tumor, and eliminate associated symptoms. Serum prolactin concentration should be monitored and treatment may be adjusted accordingly over time. If the initial treatment is unsuccessful, surgery or radiation therapy may be considered.


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