[The evolving role of surgery in the management of pituitary prolactinomas]

Recently, the therapeutic paradigm for pituitary prolactinomas has shifted from a single-pathway of "drug priority" approach toward a multidisciplinary assessment and individualized treatment model. The "Consensus on the diagnosis and treatment of pituitary prolactinoma(2025 edition)" combines the latest evidence-based medicine and technological advances at home and abroad to expand the indications and clinical role of surgical intervention. This article systematically reviews the major differences between the two versions of consensus regarding surgical recommendations, highlighting that with the widespread adoption of endoscopic transnasal techniques, surgery is now recognized as a first-line or co-primary treatment option in selected patients, particularly for those with well-circumscribed microadenomas, macroadenomas, and women of reproductive age. In addition, the article further discusses the role of surgery in fertility management, long-term remission, and in cases with poor drug tolerance or adherence. It also emphasizes that the surgen's experience, technical proficiency, and multidisciplinary collaboration are still the key prerequisites for ensuring the safety and effectiveness of treatment. The publication of the 2025 consensus marks a major conceptual shift in the management of prolactinomas, offering important guidance and practical paths for establishing a more precise, effective, and humanistic comprehensive diagnosis and treatment system.