The management of invasive giant prolactinomas (IGP) has been an area of some controversy. The relative roles of transsphenoidal surgery, craniotomy, radiation therapy and dopamine agonist based medical therapy are gradually becoming clarified. We report the results of management of 30 patients with IGP. Surgery was the initial therapy in 18 patients and was nearly always followed by adjunctive treatment with radiotherapy and/or bromocriptine. A second group of 12 patients had initial therapy with bromocriptine; 6 had subsequent radiotherapy and only 1 had transsphenoidal surgery. Outcomes with regard to relief of mass effect, visual improvement, pituitary function and complications of therapy were superior in the bromocriptine treated patients.