The Endocrine Society has released a new clinical practice guideline for the diagnosis and treatment of patients with hyperprolactinemia.

• People with high prolactin levels who have few or no symptoms and no demonstrable pituitary tumor may not need treatment, but infertile or pregnant patients, and individuals with bothersome symptoms require specialized treatment depending on the cause of their condition
• A single measurement of serum prolactin level can confirm the diagnosis if the level is above the upper limit of normal and the serum sample was obtained without excessive venipuncture stress.
• Dynamic testing of prolactin secretion is not recommended to diagnose hyperprolactinemia.
• Macroprolactin evaluation is recommended in patients with asymptomatic hyperprolactinemia.

• Patients with asymptomatic medication-induced hyperprolactinemia should not be treated.
• Symptomatic patients with prolactinomas who cannot tolerate high doses of cabergoline or who are unresponsive to dopamine agonist therapy should be offered trans-sphenoidal surgery. Temozolomide therapy is recommended for patients with malignant prolactinomas.
• Women with prolactinomas should discontinue dopamine agonist therapy as soon as pregnancy is recognized, except for selected patients with invasive macroadenomas or adenomas abutting the optic chiasm.
• Serum prolactin measurements should not be performed during pregnancy.
• Unless there is clinical evidence for tumor growth, such as visual field impairment, routine use of pituitary MRI during pregnancy is not recommended in patients with microadenomas or intrasellar macroadenomas.
• Women with macroprolactinomas that do not shrink during dopamine agonist therapy or women who cannot tolerate bromocriptine or cabergoline should be counseled regarding the potential benefits of surgical resection before attempting pregnancy.
• Pregnant women with prolactinomas who experience severe headaches and/or visual field changes should have formal visual field assessment followed by MRI without gadolinium.

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