Polycystic ovarian syndrome and pituitary macroadenoma a deadly combination with good outcome

We are presenting here a case of polycystic ovarian syndrome, an endocrine disorder, afflicting 5-13% females of reproductive age, causing 70-80% infertility associated with pituitary macroadenoma i.e. size >10 mm & prolactin level >250 ng/mI. PCOS has a higher relationship with metabolic disturbance and hypothalamic-pituitary-ovarian axis function disorder. Prolactinoma is present in about 50% women with hyperprolactinemia and 33% present with galactorrhea. Our patient was a 22 yrs nulligravida married since 3 yrs first presenting 5 yrs back with complaints of secondary amenorrhea with galactorrhea and infertility. On evaluation she was diagnosed as PCOS and pituitary macroadenoma on MRI. We medically treated her with tab. cabergoline in consultation with endocrinologist and neurosurgeons opinion. Being a compliant patient with regular follow up she conceived twice with good outcome and breastfed her babies on medical management only. Now she has 2 children (male child of 3 yrs and 1 month). Dilemma in management options will be discussed.