2nd May 2024

A 55-year-old woman presents with headaches and visual disturbances for the past 6 months.

A 55-year-old woman presents with headaches and visual disturbances for the past 6 months. She reports a loss of peripheral vision in both eyes. She has no history of hormonal disorders. Her BMI is 26 kg/m². Ophthalmologic examination reveals bitemporal hemianopia. MRI of the brain shows a 2 cm pituitary adenoma abutting the optic chiasm.

Which is the most appropriate initial treatment?