Endocrine inactive pituitary microadenomas are ones of the most common incidental findings in neuroimaging. Their prevalence is up to tens of cases per 100.000. According to current data, the vast majority of microadenomas remain stable over long-term follow-up, and the risk of progression, hypopituitarism, or the need for surgical intervention is extremely low. Clinical factors such as baseline adenoma size, gender and age have not proven predictive value for the risk of microadenoma growth. Current recommendations for follow-up vary significantly. There is evidence of safety of less aggressive strategies (delaying the first MRI for up to 3 years without clinical manifestations and no routine hormonal screening in patients with stable course). This approach combines clinical effectiveness and cost-effectiveness. Thus, current data allow us to consider endocrine inactive pituitary microadenomas as lesions with favorable prognosis. Revising international guidelines in favor of more rational and personalized surveillance strategies appears to be a justified and necessary step to optimize clinical practice.