OSCE — Prolactinoma · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Prolactinoma.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Prolactinoma is a benign pituitary lactotroph adenoma that autonomously secretes prolactin — the most common hormonally active pituitary tumour, accounting for around 40 to 45 percent of functioning pituitary adenomas. Hyperprolactinaemia inhibits hypothalamic GnRH, lowering FSH and LH and producing hypogonadotropic hypogonadism: in women oligomenorrhoea or amenorrhoea, galactorrhoea, infertility and low libido; in men reduced libido, erectile dysfunction and infertility. A macroprolactinoma (10 mm or more) adds mass effect — bitemporal hemianopia (optic chiasm compression), hypopituitarism and cranial nerve palsies. Diagnosis rests on a fasting serum prolactin (over 4000 mU/L or 200 ng/mL e

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.
State focused examination priorities.
List first-line investigations and any named score/criteria.
Give immediate resuscitation steps.
Outline definitive management with doses/routes where standard.
Name complications and disposition (ward / HDU / theatre / discharge safety-net).
Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	Amenorrhoea with galactorrhoea in a woman of reproductive age — always do a beta
Safety	Headache with bitemporal visual field loss and raised prolactin — macroprolactin
Safety	A very large pituitary tumour with a low reported prolactin — consider the high-
Communication	Clear plan and safety-netting

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.