“The risk for clinically significant growth in women with microadenomas is extremely low-only 1-2%.
About 5% will develop asymptomatic tumor enlargement (as determined by imaging), and essentially none will ever require surgical intervention.
The risk is significantly higher (15-20%) in those with macroadenomas.”
Thus option ‘C’ macroadenomas >1 cm is associated with bad prognosis is absolutely correct. (as macroadenoma means only it is > 1 cm)
It is recommended that pregnant women with microdenomas should be regularly inquired for headache and visual symptoms.
“Those with macroadenomas should have visual field testing during each trimester. CT or MRI is recommended only if symptoms develop” — Thus option d-regular visual checkup is also correct.
As far as option ‘b’ i.e. increase in prolactin levels means worse prognosis is concerned.
In pregnancy prognosis does not depend on the levels of prolactin, this is because during pregnancy the levels of circulating estrogen is very high.
This results in a parallel increase in the circulating levels of prolactin.
Prolactin levels begin to rise at 5-8 weeks of gestation period and it parallels the increase in the size and number of lactotrophs.
At the end of the first trimester, serum prolactin levels are approximately 20-40 ng/mL. It further increases to 50-150 ng/mL and are 100-400 ng/mL at the end of the second an third trimester respectively.
So per increase in prolactin levels does not indicate poor prognosis, as during pregnancy, there is going to be increase in prolactin levels.
Thus option b is incorrect.