1. Drug therapy Drug therapy has become the first choice for the initial treatment of pituitary prolactin (PRL) adenoma, and the efficacy of dopamine receptor agonists has been recognized. Bromocriptine is currently the most widely used dopamine receptor agonist. Cartegolide is a newer dopamine agonist. Dopamine agonists cause a rapid decrease in serum PRL levels, a reduction in tumor size, and a gradual improvement in visual acuity after a period of tumor shrinkage. Tumor shrinkage can occur within 1-2 weeks of drug administration, mostly within the first 3 months of drug administration. In some patients, tumor shrinkage is slow and lasts for several months, during which time MRI dynamic observation is required. Most patients need to take the drug for a long time and the tumor size can increase again after stopping the drug. About 10% of PRL macroadenomas do not decrease in size after dopamine agonists are administered, and a very small number of patients may develop drug resistance. For patients with PRL levels of 80-200 μg/L and undiagnosed PRL adenoma, experimental treatment with dopamine agonists under close monitoring is reasonable. if visual loss or tumor volume does not decrease after treatment (no more than 3 months), surgery may be an option. pituitary adenomas with PRL levels below 80 μg/L have few PRL adenomas and should be resected and subjected to Histological diagnosis should be performed. Transsphenoidal surgery or gamma knife treatment or a combination of both may be promptly chosen if the following conditions occur during observation on medication: (i) drug resistance phenomenon or intolerance of drug side effects; (ii) complete reduction of the tumor to the saddle; (iii) residual tumor only in the cavernous sinus or slope site <2.0 cm; (iv) complications such as cerebrospinal fluid leakage or pituitary stroke. Pregnancy: Some physicians recommend that female patients with PRL macroadenoma receive medication for at least 6 months, preferably 12 months, while MRI is performed to observe the suprasellar tumor before planning to become pregnant. If the tumor shrinks into the pituitary fossa, dopamine agonists can be discontinued when pregnancy is confirmed, in which case the likelihood of the tumor growing again is less than 10%; if neurological symptoms develop, bromocriptine should be taken during pregnancy; if the tumor has extended significantly into the suprasellar fossa before pregnancy, either surgical treatment or continued bromocriptine during pregnancy is recommended. For women applying bromocriptine to induce ovulation or taking bromocriptine during pregnancy, there is no evidence of teratogenic effects of the drug, but it is still recommended that the drug should preferably not be used during pregnancy unless forced to do so. For patients applying carte blanche, it is recommended to stop the drug 1 month before pregnancy. 2. Surgery Surgery is the most fundamental treatment for patients with PRL adenomas that are intolerant or dopamine agonist resistant. The vast majority of tumors can be resected through different procedures via the transsphenoidal sinus approach, while the remaining tumors require the option of craniotomy (including the pterygoid point approach and other skull base approaches). Gamma knife is mainly used as an adjuvant or supplement to drug or surgical treatment, and can be applied to patients with poor effect on dopamine agonist treatment, tumor remnants, and obvious invasion of cavernous sinus. 4.Observation It has been reported that only 7% of PRL microadenomas can develop into larger tumors. Therefore, for patients with PRL microadenomas who have normal menstrual cycles and libido and have light lactation and are not planning to get pregnant, it may not be necessary to start treatment immediately, and regular monitoring of serum PRL levels may be an option.