Does a patient with prolactinoma require cortisol before undergoing pituitary surgery?

Hello doctor,

I would appreciate your opinion about a case in which pituitary surgery has been indicated. A patient in his early 70s was diagnosed with a prolactinoma ten years ago. He was prescribed a tablet of Dostinex 0.5 mg per week, which was then reduced to 0.5 mg per two weeks. The prolactin levels went down, but tumor size was slowly increasing. He was evaluated this month, but his prolactin levels are still low, and the optic chiasma compression affects the visual fields. I would like to know if we can assume that his adenoma is drug-resistant even though the maximum dosage reported in the literature is 3.5 mg of Cabergoline per week. As his prolactin levels are low, will the tumor shrink on increasing the dose? The patient took a tablet of Sotalol and had a history of Wolf-Parkinson-White syndrome.

Thank you.

Thank you doctor for the reply,

I would like to know if Cortisol is required before surgery, as they usually inject Hydrocortisone right before surgery, and dosage might depend on initial levels.

Thank you.