Young women with secondary amenorrhoea and galactorrhoea. MRI shows a tumor of < 10mm diameter in the pituitary fossa. Treatment is –
**Core Concept**
Amenorrhoea and galactorrhoea in young women are characteristic symptoms of prolactinoma, a type of pituitary adenoma that secretes excessive prolactin. The presence of a small tumor (< 10mm) in the pituitary fossa on MRI confirms this diagnosis.
**Why the Correct Answer is Right**
The treatment of choice for a prolactinoma, especially in a young woman with a small tumor, is dopamine agonist therapy, typically with cabergoline. This medication works by stimulating dopamine receptors in the pituitary gland, which in turn inhibits the secretion of prolactin. In many cases, this therapy can shrink the tumor and normalize prolactin levels without the need for surgery.
**Why Each Wrong Option is Incorrect**
**Option A:** Surgery would be considered if the tumor were larger, causing visual field defects or other complications. In this case, the small size of the tumor and the effectiveness of medical therapy make surgery unnecessary.
**Option B:** Radiotherapy is typically reserved for cases where the tumor is resistant to medical therapy or has caused significant visual field defects.
**Option C:** Transsphenoidal surgery is a treatment option for larger prolactinomas or those causing complications, but it is not the first line of treatment for a small tumor.
**Clinical Pearl / High-Yield Fact**
Dopamine agonist therapy is often effective in shrinking prolactinomas and normalizing prolactin levels, making it a first-line treatment for this condition.
**Correct Answer: A. Cabergoline**