Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the preferred treatment for prolactinoma?

1. Cabergoline > Bromocriptine

2. Bromocriptine > Cabergoline

3. Transsphenoidal resection

4. Radiation therapy

The correct answer is: Cabergoline > Bromocriptine

Cabergoline is typically preferred over Bromocriptine for the treatment of prolactinomas due to its greater efficacy, more favorable side effect profile, and improved patient adherence. Cabergoline is a dopamine agonist that directly stimulates dopamine receptors, leading to a decrease in prolactin secretion and a reduction in tumor size in many patients. Studies have shown that cabergoline is more effective in normalizing serum prolactin levels and achieving tumor shrinkage compared to bromocriptine. Additionally, cabergoline has a more convenient dosing schedule—often requiring administration just once or twice weekly—while bromocriptine generally needs to be taken daily. Bromocriptine does have a long history of use and can be effective, but its side effects, which may include nausea, dizziness, and fatigue, can be more pronounced. This can impact patient compliance, making cabergoline the more appealing option in most scenarios. While transsphenoidal resection and radiation therapy are effective treatments for certain cases, especially when medical therapy fails or for larger tumors, the first-line approach for prolactinomas is usually pharmacological management with a dopamine agonist, and cabergoline is often preferred for the reasons outlined above