Endocrinology Question 65

A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident.

She is otherwise healthy and takes no medications. She went through menopause at age 51. She has night sweats two to three times per month and occasional hot flushes. These have improved over the past decade and are not bothersome. She is not sexually active. She has never taken hormone replacement therapy. She has had no change in vision, headaches, or galactorrhea.

On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 110/63 mm Hg, pulse rate is 82/min, and respiration rate is 14/min. BMI is 26. There is axillary and pubic hair loss. Visual fields are intact. There are no findings suggestive of Cushing syndrome or acromegaly.

Pituitary MRI shows a 7-mm adenoma in the anterior sella. The tumor is not invasive. It does not approximate the optic chiasm. The pituitary stalk is mid-line.

Which of the following is the most appropriate management?

A Begin dopamine agonist

B Gamma knife stereotactic radiosurgery

C Repeat testing in 12 months

D Transphenoidal resection

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