The majority of pituitary adenomas associated with MEN 1 secrete prolactin or growth hormone. For both types, medical treatment is an acceptable option, particularly for prolactinomas. A significant number of patients with this syndrome will, however, require surgery because of ineffectiveness of medical therapy or compression or invasion of parasellar structures. This article discusses current strategies for the medical and surgical management of prolactinomas and of acromegaly, with special attention to the diagnostic and therapeutic pitfalls associated with MEN 1.