Giant prolactinomas are extremely rare in the pediatric population. We describe the case of a giant prolactinoma in a girl aged 14 years and 9 months old presented with delayed puberty. Medical treatment with dopamine agonist cabergoline resulted in a rapid normalization of prolactine levels and an impressive shrinkage and liquefaction of the mass as illustrated in serial MRIs. The therapeutic dilemma regarding the type of treatment (medical versus surgical) has now been replaced by the dilemma regarding the optimal treatment strategy and duration. Initial, rather optimistic, estimations regarding the probability of treatment discontinuation without increased relapsing risk have now been replaced by guidelines with more strict criteria for selecting candidates for treatment discontinuation.