Pituitary Disorders USMLE Step 1 Practice Question
A 38-year-old woman with macroprolactinemia presents with secondary amenorrhea, galactorrhea, and decreased libido despite 6 months of cabergoline therapy. Vitals: BP 118/76, HR 78, RR 14, Temp 37°C, SpO2 98%. Serum prolactin remains elevated at 92 ng/mL; TSH normal. Pregnancy test negative. MRI shows a 1.2-cm sellar mass without suprasellar extension or visual field defects. Which of the following best explains her persistent symptoms despite dopamine agonist therapy?
Answer choices
- AMacroprolactin is biologically inactive and cannot cause these symptoms
- BDevelopment of prolactin-secreting metastatic disease
- CDopamine agonist resistance requiring surgery
- DPregnancy occurring on dopamine agonist therapy
- EPoor medication adherenceCorrect answer
- FHypothyroidism-induced elevation of thyrotropin-releasing hormone stimulating prolactin secretion
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