Pituitary adenomas represent 9% of intracranial neoplasms. Typical presenting manifestations include amenorrhea, infertility, visual field abnormalities, and headache. Diagnosis is often made with brain MRI, visual field testing, and serum hormone assay. Prolactinoma, the most common type of pituitary adenoma, usually responds to therapy with a dopamine agonist such as bromocriptine or cabergoline. Rare refractory cases, large tumors, and pituitary adenomas that secrete other hormones are often treated with transsphenoidal surgical resection. Stereotactic radiosurgery is emerging as a second-line option. In this update, Drs. Jai Grewal and Harpreet Grewal discuss surgical options, and the role of stereotactic radiosurgery in treating pituitary adenomas.