[Medical treatment of prolactinoma. Quo usque tandem..]

Dopamine agonists are the first choice therapy for prolactinoma. They decrease tumor secretion and volume, restore the gonadotropic axis, preserve the remaining pituitary functions, and correct the ophthalmologic symptoms. They do not cause hypopituitarism, contrary to surgery or radiotherapy. The latter are reserved for the rare patients who display an inappropriate response to dopamine agonists. It is important to determine the circumstances under which remission is observed after prolonged drug therapy. Recent data indicate significant percent remission in patients with macro- or microprolactinoma. However, the data do not allow to determine how therapy should be performed to better reach that goal, nor to identify predictive factors of this favorable outcome.