594 Obstetrics and Gynecology Board Review •••
❍ What is the regimen for cabergoline therapy?
Start 0.25 mg orally twice weekly, increase by 0.25 mg twice weekly at 4-week intervals; maximum 1 mg twice
weekly.
❍ What is the definition of a microadenoma and a macroadenoma?
Microadenoma is <10 mm in diameter.
Macroadenoma is 10 mm in diameter or greater.
❍ In asymptomatic patients with hyperprolactinemia, what laboratory test should be assessed to see if the
elevated prolactin level consists of less bioactive forms?
Macroprolactin
❍ What percentage of hyperprolactinemic women achieve pregnancy with dopamine agonist therapy?
80%.
❍ What group of patients with prolactin adenomas should undergo surgery?
Patients with symptoms of hyperprolactinemia that did not respond to medical therapy, and patients with
adenomas that do not shrink during therapy or patients with giant lactotroph adenomas (>3 cm) wishing to
become pregnant.
❍ True or False. Women are more common than men to be dopamine agonist resistant.
False.
❍ What percentage of patients are resistant to bromocriptine and to cabergoline?
25% and 10%.
❍ What clinical risk is present in patients with long-term use of high-dose cabergoline?
Cardiac valvular regurgitation. But, most studies have shown no evidence of clinically significant heart valvular
disease in patients receiving the usual doses of cabergoline.
❍ What is the best single predictor of persistent cure of prolactin adenoma with surgery?
Serum prolactin concentration of 5 ng/mL or less on the first postoperative day.
❍ What is the role of radiation therapy in patients with lactotroph adenomas?
It decreases the size and secretion of adenoma, but it occurs slowly and prolactin may be elevated many years after
treatment. Radiation is limited to patients after the debulking surgery of very large macroadenomas. With this
treatment, there is 50% chance of loss of anterior pituitary hormone secretion during subsequent 10 years.
❍ Should patients with asymptomatic medication-induced hyperprolactinemia be treated?
No.