We thank De Sousa and co-authors for their comments on our recently published Pituitary Society Consensus Statement on diagnosis and management of prolactin-secreting pituitary adenomas. In our Consensus Statement (Petersenn, S. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat. Rev. Endocrinol. 19, 722–740 (2023)¹), we recommended discussion of first-line surgery alongside first-line medical treatment with dopamine agonists by expert endocrinologists and neurosurgeons in a selected subgroup of patients. In their correspondence (De Sousa, S. et al. Tumour fibrosis in dopamine agonist-exposed prolactinomas is a diminishing concern. Nat. Rev. Endocrinol. https://doi.org/10.1038/s41574-024-00976-y (2024)²), De Sousa and co-authors question the routine offer of surgery before attempting cabergoline, given the risk of potentially permanent operative complications in contrast to the reversibility of dopamine-induced toxicity. Certainly, risk–benefit reasoning should account for factors that might influence treatment outcomes (such as mass morphology, baseline serum levels of prolactin and sex) and also consider treatment-associated adverse effects or complications and patient preference. However, we would like to point to a few additional important considerations.

我们感谢 De Sousa 和合著者对我们最近发表的垂体学会关于泌乳素垂体腺瘤的诊断和治疗的共识声明的评论。在我们的共识声明中（Petersenn, S. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society International Consensus Statement. Nat. Rev. Endocrinol . 19 , 722–740 (2023) ¹ ），我们建议讨论由内分泌专家和神经外科医生对选定的亚组患者进行一线手术，同时使用多巴胺激动剂进行一线药物治疗。在他们的信件中（De Sousa, S. 等人。暴露于多巴胺激动剂的催乳素瘤中的肿瘤纤维化正在逐渐减少。Nat . Rev. Endocrinol 。 https://doi.org/10.1038/s41574-024-00976-y (2024 ) ² )，考虑到与多巴胺引起的毒性的可逆性相比，存在潜在永久性手术并发症的风险，De Sousa 和合著者对尝试卡麦角林之前常规手术的做法提出了质疑。当然，风险效益推理应考虑可能影响治疗结果的因素（例如肿块形态、泌乳素基线血清水平和性别），并考虑与治疗相关的不良反应或并发症以及患者偏好。然而，我们想指出一些额外的重要考虑因素。