Fig. 3: Treatment algorithm for prolactinoma.

a, Prolactinomas are treated with surgery or dopamine agonists depending on adenoma size, clinical factors and patient preference. In microadenomas, patient preference for observation or HRT can also be considered depending on menopausal and gonadal status (dashed lines). b, Follow-up should consider serum levels of prolactin, changes on MRI, need for HRT, complications or adverse effects and potential for dopamine agonist withdrawal. c, Recurrence or lack of remission should prompt dopamine agonist dose increase or consideration for surgery; intolerability can be addressed by switching to a different dopamine agonist or consideration for surgery. In all of these cases, management at Pituitary Tumour Centres of Excellence is recommended. GH, growth hormone; HRT, hormone replacement therapy.