American Board of Psychiatry and Neurology (ABPN) Practice Exam

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A patient presenting with elevated serum prolactin levels and specific neurological symptoms is likely suffering from which condition?

  1. Pituitary macroadenoma

  2. Thalamic hemorrhage

  3. Acute left parietal stroke

  4. Midbrain infarct

The correct answer is: Pituitary macroadenoma

Elevated serum prolactin levels in conjunction with neurological symptoms strongly suggest the presence of a pituitary macroadenoma. A pituitary macroadenoma is a benign tumor of the pituitary gland that can disrupt the normal production and regulation of hormones, particularly prolactin. This condition can lead to hyperprolactinemia, which may present with various symptoms, including reproductive issues like amenorrhea or galactorrhea, and potentially neurological manifestations due to pressure effects on nearby structures such as the optic chiasm or adjacent brain tissue. In contrast, thalamic hemorrhage, acute left parietal stroke, and midbrain infarct do not typically cause elevated prolactin levels. These conditions result from vascular events affecting specific brain regions, which may lead to focal neurological deficits or altered sensorium, but they are not associated with the hormonal dysregulation seen with pituitary tumors. Therefore, when someone presents with both elevated prolactin and neurological symptoms, the most reasonable conclusion would point towards a pituitary macroadenoma.