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Cabergoline
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Estrogen
Octreotide
Pimozide
Transphenoidal resection
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This female patient with galactorrhea and amenorrhea most likely has a prolactinoma, which is managed with cabergoline as a first-line treatment. Prolactinoma is the most common benign pituitary tumor and causes elevated levels of prolactin, which lead to symptoms of galactorrhea, amenorrhea, gynecomastia, virilization in females, loss of libido, and infertility (due to low levels of FSH and LH from decreased GnRH). If the pituitary tumor is large in size, it may compress the optic chiasm from below and lead to bitemporal hemianopsia. Prolactinoma is treated with a dopamine agonist as first line (e.g. cabergoline, bromocriptine) due to dopamine’s effect in suppressing prolactin production. Trans-sphenoidal resection is a treatment option for large, refractory tumors. Figure A/Illustration A shows an MRI with contrast featuring a pituitary microadenoma. Incorrect Answers: Answer 2: Estrogen stimulates prolactin secretion and would not be used to treat a prolactinoma. Answer 3: Octreotide is a somatostatin analog that is used to treat acromegaly, caused by an excess secretion of growth hormone. Answer 4: Pimozide is an antipsychotic that functions as a dopamine antagonist. Dopamine antagonists stimulate prolactin secretion and thus would not be used to treat a prolactinoma. Answer 5: Trans-sphenoidal resection is used to treat large, refractory pituitary tumors after using a dopamine agonist as a first-line treatment. Bullet Summary: Dopamine agonists are used as first-line treatment for prolactinoma.
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