Pituitary adenoma and neoplasm: The Daily PANCE Blueprint

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Pituitary adenoma and neoplasm: The Daily PANCE Blueprint

A 40-year-old individual presents to your office with headaches, visual disturbances, and menstrual irregularities. On examination, you note bitemporal hemianopsia. Laboratory tests reveal elevated prolactin levels. An MRI of the brain identifies a mass in the sella turcica, consistent with a lactotroph adenoma (prolactinoma). What is the next best step in the management of this patient?

A. Immediate Transsphenoidal Surgery
B. Dopamine Agonist Treatment
C. Radiation Therapy
D. Chemotherapy
E. Observation Only

Answer and topic summary

The answer is B. Dopamine Agonist Treatment.

A dopamine agonist drug should usually be the first treatment for patients with hyperprolactinemia of any cause, including lactotroph adenomas (prolactinomas) of all sizes. These drugs decrease serum prolactin concentrations and decrease the size of most lactotroph adenomas. Following the decrease in serum prolactin and adenoma size in patients with macroadenomas, visual and pituitary function often return to normal. Transsphenoidal surgery is considered only when dopamine agonist treatment has been unsuccessful or in specific situations such as a giant lactotroph adenoma in a woman wishing to become pregnant.

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