Transsphenoidal surgery and medical treatment are the cornerstones of the management of pituitary adenomas. However, the optimal therapy should be chosen based on the type of tumor, the patient, and the tumor characteristics. For nonfunctional adenomas surgery is still the first-line treatment. However, for prolactinomas surgery has been replaced by medical treatment. In the other functional pituitary adenomas a more balanced approach is needed to decide between surgery and medical therapy as first-line treatment. In the majority of cases a combination of treatment modalities is needed. In acromegaly and TSH-secreting adenomas medical treatment has a more prominent role than in Cushing's disease. In this chapter the efficacy and side-effects of the different medical therapies is discussed according to adenoma type.