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A 41-year-old female is seen for amenorrhea of eight months duration. Her pregnancy tests have been negative during this period. She denies headaches, visual change, galactorrhea, hot flashes, dyspareunia, weight change, or loss of secondary sexual characters. Her past medical history and family history are unremarkable. She is not on any medications, including over-the-counter medications. She denies the use of tobacco, alcohol or intravenous drugs. The physical examination is unrevealing. Her routine labs are within normal limits. Her hormone profile reveals a prolactin level of 50 ng/mL (normal 5-20 ng/ml). Her LH is undetectable, and FSH is low normal. The level of serum α-subunits is markedly increased. Her serum IGF1 levels are normal. MRI of the pituitary shows a 2 cm pituitary tumor with suprasellar extension. What is the most appropriate management of this patient?

A) Transphenoidal pituitary surgery
B) Estrogen-progesterone cyclically
C) Bromocriptine orally
D) Pituitary radiation
E) Octreotide

C.

A.

u people must give the reason ..

C
macroadenomas ( > 10 mm ) are first treated medically and then proceed to surgery for higher cure rates.
Any inputs appreciated.

low LH and FSH pluse high alpha subunit = non functioning pituitary adenoma
Tx: transphenoidal pituitary surgery
A

ans cccccccccc this is nonfounctional pituitary adenoma.

by the way this is UW question

Agree with christine09. Transphenoidal pituitary surgery.
For nonsecretory/non-functioning pituitary adenoma the first-line therapy is transphenoidal surgery. Normal gonadal function will be restored after the surgery.

Thanks

hey drock and christine09 -- u people were using CK forum as well -- i remem -- i used to be nowckturn over there .. any memory ??

can u people describe which alpha unit they are asking about?? and and how do u say it as nonfunctioning pituitary adenoma?? Prolactinoma can can suppress both FSH and LH by decreasing GnRH.