Hemorrhage in a pituitary microprolactinoma presenting as primary infertility with mild hyperprolactinemia

Pituitary apoplexy is usually associated with macroadenomas and overt neuro-ophthalmic symptoms. Hemorrhage within pituitary microadenomas is rare and may present subtly, resulting in delayed diagnosis. A young woman presented with primary infertility and mildly elevated serum prolactin levels. Following initiation of cabergoline therapy, she developed new-onset severe headache. Magnetic resonance imaging revealed hemorrhage within a previously undiagnosed pituitary microprolactinoma. Conservative management with modification of dopamine agonist therapy led to symptomatic improvement. Mild hyperprolactinemia may occasionally mask underlying pituitary pathology. Severe headache after dopamine agonist initiation should prompt early neuroimaging, regardless of adenoma size. Early recognition allows appropriate conservative management and preservation of fertility.