Transsphenoidal surgery should be considered when:

●Dopamine agonist treatment has been unsuccessful in lowering the serum prolactin concentration or size of the adenoma, and symptoms or signs due to hyperprolactinemia or adenoma size persist after several months of treatment at high doses.

●A woman has a giant lactotroph adenoma (eg, >3 cm) and wishes to become pregnant even if the adenoma responds to a dopamine agonist. The rationale for this approach is that if the patient becomes pregnant and discontinues the agonist for the duration of pregnancy, the adenoma may increase to a clinically important size before delivery.