<prompt> A patient is diagnosed with pituitary tumour, prolactinoma encircling the carotid aery. What is the best line of management?Wait and watchTranssphenoidal surgical resectionRadiotherapyCombination  <response>: Treatment O Dopamine agonist, bromocriptine, can shrink prolactinomas in 75 of patients with macroadenomas in 6-8 weeks, but only as long as therapy is maintained. O Bromocriptine may also work on GH-secreting tumors with shrinkage in 20 O Octreotide can reduce GH levels in 71 of patients with a significant reduction in tumor volume in 30 of cases Indication of surgery as an Initial treatment GH-secreting tumors Primary cushings disease Any adenoma causing acute visual deterioration Non prolactin-secreting macroadenomas causing symptoms by mass effect Surgical approach of choice: Sublabial or intransal trans-sphenoidal approach. 