Nonfunctioning pituitary adenomas (NFPA) account for approximately 30% of clinically evident pituitary tumors in adults and may present with mass effect, including visual compromise, headache, or hypopituitarism. Alternatively, NFPA can be incidental findings on brain imaging. Neuro-ophthalmic evaluation is recommended for lesions impinging on the optic apparatus. Transsphenoidal pituitary surgery is the treatment of choice for patients with nonfunctioning pituitary macroadenomas that cause mass effect or grow toward the optic chiasm. Radiation therapy is second-line therapy for some patients with persistent or recurrent tumors postoperatively; cabergoline therapy may have a role in select patients.