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The goal of this review is to propose a giant prolactinoma definition and discuss the available therapeutic options for biochemical and tumour volume control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive search of all published studies was performed between<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril and<jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ovember 2012 in electronic databases (<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ub<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ed and<jats:styled-content style=\"fixed-case\">O<\/jats:styled-content>vid).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A giant prolactinoma should be defined as an adenoma with a maximum diameter of more than 4\u00a0cm that is associated with serum prolactin above 5300<jats:styled-content style=\"fixed-case\">mIU<\/jats:styled-content>\/l. Regarding treatment, cabergoline is the preferred dopamine agonist for medical management of giant prolactinomas because of its excellent efficacy and tolerability. Normalization of prolactin level and significant tumour reduction may be achieved in the majority of patients. Combined therapy, particularly cabergoline and surgery, may be necessary due to the large tumour load. Radiotherapy and temozolomide may be used for patients with aggressive giant prolactinomas in whom tumour volume control is not achieved with cabergoline and surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a scarcity of large studies about the management of giant prolactinoma. Cabergoline is the first\u2010line treatment. However, caution should be exercised when comparing efficacy rates among the different treatment modalities due to the variability in study design and data quality. In this scenario, a \u2018standard\u2019 definition for giant prolactinomas and larger series may be helpful to assess the real efficacy and safety of each therapeutic modality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.12242","type":"journal-article","created":{"date-parts":[[2013,5,10]],"date-time":"2013-05-10T15:51:09Z","timestamp":1368201069000},"page":"447-456","source":"Crossref","is-referenced-by-count":103,"title":["Giant prolactinomas: the therapeutic approach"],"prefix":"10.1111","volume":"79","author":[{"given":"Aline B.","family":"Moraes","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Medical School and Clementino Fraga Filho University Hospital Federal University of Rio de Janeiro Rio de Janeiro Brazil"},{"name":"Psychoneuroendocrinology Unit State Institute of Diabetes and Endocrinology of Rio de Janeiro Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cintia","family":"Marques dos Santos Silva","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Medical School and Clementino Fraga Filho University Hospital Federal University of Rio de Janeiro Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Vieira Neto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Medical School and Clementino Fraga Filho University Hospital Federal University of Rio de Janeiro Rio de Janeiro Brazil"},{"name":"Endocrinology Section Federal Hospital of Lagoa Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f4nica R.","family":"Gadelha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrine Unit Medical School and Clementino Fraga Filho University Hospital Federal University of Rio de Janeiro Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,6,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-005-5079-0"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2002.97.2.0299"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.7.2102"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2003.01770.x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-06-0646"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90668-1"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-005-5087-0"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2006.104.1.54"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2009.24.5.874"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12022-009-9057-3"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007010170075"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1692"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1996.663486.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1025334001748"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.4.996"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1480325"},{"key":"e_1_2_12_18_1","first-page":"152","article-title":"Gender\u2010related differences in prolactinomas. 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