Gynaecological endocrinology: macroprolactinaemia: practice question

A OBG 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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OBG · Gynaecological endocrinology: macroprolactinaemia

Sample item

A woman with mildly raised prolactin has regular cycles, no galactorrhoea and a normal pituitary MRI. After polyethylene glycol precipitation, her measured prolactin falls to normal. What does this indicate?

AMicroprolactinoma needing cabergolineBMacroprolactin, usually needing no treatmentCStalk compression by a craniopharyngiomaDPrimary hypothyroidism

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

The answer and the reasoning

B. Macroprolactin, usually needing no treatment

Macroprolactin is a complex of prolactin with immunoglobulin that is detected by the assay but has little biological activity. It explains asymptomatic hyperprolactinaemia, and recognising it avoids unnecessary imaging and dopamine agonist therapy.

Option by option

A. Microprolactinoma needing cabergoline
A true microprolactinoma would keep the bioactive prolactin high after precipitation.
B. Macroprolactin, usually needing no treatment (correct)
Correct. A fall after precipitation shows the excess is biologically inactive macroprolactin.
C. Stalk compression by a craniopharyngioma
Stalk compression gives bioactive prolactin and usually visible suprasellar disease.
D. Primary hypothyroidism
Hypothyroidism is tested through TSH and does not change the precipitation result.

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.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Macroprolactin, usually needing no treatment. Macroprolactin is a complex of prolactin with immunoglobulin that is detected by the assay but has little biological activity.

Why is "Microprolactinoma needing cabergoline" not the answer?

A true microprolactinoma would keep the bioactive prolactin high after precipitation.

Why is "Stalk compression by a craniopharyngioma" not the answer?

Stalk compression gives bioactive prolactin and usually visible suprasellar disease.

Why is "Primary hypothyroidism" not the answer?

Hypothyroidism is tested through TSH and does not change the precipitation result.

What concept does this question test?

It tests Gynaecological endocrinology: macroprolactinaemia in OBG. It explains asymptomatic hyperprolactinaemia, and recognising it avoids unnecessary imaging and dopamine agonist therapy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Gynaecological endocrinology: macroprolactinaemia?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.