How do you manage microprolactinomas in women who are resistant to dopamine agonists, especially considering potential tumor growth during pregnancy?

Microprolactinomas rarely grow during pregnancy, so clinical monitoring is appropriate. If infertility becomes an issue and the patient is unable to tolerate a dopamine agonist or doesn't respond, which is rare, surgery is an option.

Surgery should be considered in small prolactinomas (even independently from DA resistance), but this should be done by a competent neurosurgeon who specializes in pituitary surgery, meaning s/he does 50 pituitary surgeries per year or more. In expert hands, the cure rate for microprolactinomas is i...