An obese 32-year-old woman with a history of gastroesophageal reflux disease (GERD) presents with amenorrhea for the past year. Review of systems is unremarkable. She has 3 children and denies tobacco, alcohol, or drug use. She has a temperature of 37°C, blood pressure of 120/80 mmHg, heart rate of 75 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 100% on room air. Visual field testing reveals no abnormality and her pregnancy test is negative. Laboratory studies reveal a serum prolactin level of 108 ng/mL. MRI of the pituitary gland confirms a 5.5-mm pituitary adenoma.
Which of the following is the next best step in management?
A. Treatment with bromocriptineTreatment with bromocriptine. The patient in this question presents with symptoms and laboratory values consistent with a prolactinoma. The presence of amenorrhea and galactorrhea in females and hypogonadism in males are classic symptoms for a prolactinoma. An adenoma of the pituitary gland less than 10 mm is called a microadenoma, which does not usually have a mass effect that would affect other pituitary hormones. The first-line treatment for all prolactinomas remains dopamine agonists such as bromocriptine and cabergoline. These agents often decrease prolactin levels to the normal range and shrink the tumor. Dopamine agonists inhibit secretion of prolactin from the anterior lobe of the pituitary gland. (B) Estrogen replacement therapy is often given to patients who experience intolerable side effects from the use of dopamine agonists, but is not first-line treatment. (C) Surgery is often indicated for those patients with prolactinoma who have visual field defects that do not improve quickly after medical treatment with dopamine agonists. Surgery is also an option for those patients who do not respond to dopamine agonists. (D) Serial prolactin levels and close observation remain an option for asymptomatic patients with prolactinoma given the slow growth (however, this patient presents with amenorrhea).