The latest Pituitary Society prolactinoma guidelines released in September include many new recommendations based on evidence published since the pre-existing 2006 Pituitary Society prolactinoma guidelines and the 2011 Endocrine Society hyperprolactinaemia guidelines. Some recommendations reflect contemporary practice, whilst others are relatively novel concepts for endocrinologists to consider in their care of patients with hyperprolactinaeemia. The most striking recommendation is for surgery to be offered upfront as an alternative to dopamine agonists to patients with microprolactinomas and selected macroprolactinomas. This talk will critically appraise the apparent paradigm shift in the surgical management of prolactinomas from traditionally selecting cases that are likely to respond poorly to dopamine agonists to now selecting cases that will respond well to surgery.