Endocrinology: prolactinoma: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: prolactinoma

Sample item

A 28-year-old woman has 8 months of secondary amenorrhoea and galactorrhoea. Pregnancy test is negative, TSH is normal, and she takes no medicines. Serum prolactin is 250 ng/mL and MRI shows an 8 mm pituitary microadenoma. What is the first-line treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Cabergoline

Dopamine agonists, preferably cabergoline, inhibit prolactin secretion through D2 receptors on lactotrophs, shrink the tumour and restore menses and fertility. Surgery is reserved for intolerance, resistance or apoplexy, and radiotherapy for refractory tumours. Before diagnosing a prolactinoma, pregnancy, hypothyroidism, drugs and renal failure must be excluded.

Option by option

  • A. Cabergoline (correct)

    Dopamine agonists are first-line even for macroadenomas.

  • B. Pituitary radiotherapy

    Radiotherapy acts slowly and causes hypopituitarism, so it is a last resort.

  • C. Transsphenoidal surgery

    Surgery is second line, used when medical therapy fails or is not tolerated.

  • D. Metoclopramide

    Metoclopramide is a dopamine antagonist that raises prolactin and would worsen the condition.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Cabergoline. Dopamine agonists, preferably cabergoline, inhibit prolactin secretion through D2 receptors on lactotrophs, shrink the tumour and restore menses and fertility.

Why is "Pituitary radiotherapy" not the answer?

Radiotherapy acts slowly and causes hypopituitarism, so it is a last resort.

Why is "Transsphenoidal surgery" not the answer?

Surgery is second line, used when medical therapy fails or is not tolerated.

Why is "Metoclopramide" not the answer?

Metoclopramide is a dopamine antagonist that raises prolactin and would worsen the condition.

What concept does this question test?

It tests Endocrinology: prolactinoma in General Medicine. Surgery is reserved for intolerance, resistance or apoplexy, and radiotherapy for refractory tumours. Before diagnosing a prolactinoma, pregnancy, hypothyroidism, drugs and renal failure must be excluded.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: prolactinoma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.