Prolactinomas are the most common functional pituitary neuroendocrine tumors, accounting for nearly half of all hormone-secreting pituitary adenomas. These can cause a wide range of symptoms, including menstrual abnormalities, infertility, galactorrhea, sexual dysfunction, headaches, and vision problems. Although women of reproductive age are most often affected, the disease can also occur in men, children, and adolescents, and tumors may become larger and more invasive if diagnosed late. Over the past decade, advances in surgery, imaging, and drug therapy have changed clinical practice and created a need for updated treatment guidance.
To address this challenge, a multidisciplinary panel consisting of Professor Sheyu Li from the Department of Endocrinology, Sichuan University, China, Professor Huijuan Zhu, Department of Endocrinology, Chinese Academy of Medical Sciences, Dr Yao Zhao and Dr Yongfei Wang, Department of Neurosurgery, Fudan University, China, and Professor Zhe Bao Wu, Department of Neurosurgery, School of Medicine, Shanghai Jiao Tong University, China, and the Chinese Pituitary Adenoma Expert Council collaborated to develop an updated evidence-based consensus on the diagnosis and treatment of prolactinomas. Experts systematically reviewed current evidence and integrated it with clinical experience to establish standardized recommendations for healthcare professionals. This study was published online in Vol. Chinese Neurosurgical Journal June 8, 2026.
The consensus development process involved 60 experts from multiple fields, including neurosurgery, endocrinology, obstetrics and gynecology, neuroradiology, radiation oncology, and evidence-based medicine. Following an internationally recognized guideline framework and the GRADE approach, the team identified important clinical questions, reviewed published studies, and finalized 36 recommendations, including screening, evaluation, diagnosis, treatment, and long-term monitoring.
One of the key messages is that early recognition can significantly improve patient outcomes. This consensus recommends serum prolactin testing in patients with suggestive symptoms and emphasizes the importance of excluding physiological, pharmacological, and other pathological causes of hyperprolactinemia before diagnosing prolactinoma. We also focus on specialized approaches to complex situations such as macroprolactinemia, the hook effect, genetic syndromes, and high-risk patients who may benefit from genetic testing.
This recommendation further emphasizes the value of advanced imaging. Although pituitary magnetic resonance imaging (MRI) remains the preferred diagnostic tool, dynamic contrast-enhanced MRI may improve detection of small tumors. The guidance also provides practical advice on imaging follow-up and identifies patients who may require vascular imaging to detect associated intracranial aneurysms preoperatively.
“The proposed consensus provides insight into the epidemiological features, clinical manifestations, diagnostic criteria, and treatment strategies of prolactinomas and recommends individualized management strategies for pregnant women, male patients, and refractory cases.” Professor Lee says. We also promote a patient-centered, multidisciplinary model that brings together experts from multiple disciplines to provide personalized and precise care.
The impact of the new guidelines could extend beyond individual hospitals. Standardized recommendations will foster collaboration among clinicians, improve consistency in patient management, and facilitate future research into difficult cases such as drug resistance, pregnancy-associated prolactinomas, and genetic disorders. In the short term, early diagnosis and more appropriate treatment selection may reduce complications and preserve fertility and endocrine function. In the long term, widespread implementation of evidence-based multidisciplinary care has the potential to improve quality of life and long-term outcomes for patients in a variety of healthcare settings.
“This consensus balances clinical needs with evidence-based international standards and provides a reliable reference for diagnosis and treatment.” say Mr. Zhu.
Overall, the updated consensus represents a major effort to translate the latest scientific evidence into practical clinical recommendations. Combining multidisciplinary expertise and evidence-based medicine provides a framework to help clinicians provide more accurate diagnosis, safer treatment, and more personalized care for patients with prolactinoma.
sauce:
Chinese Academy of Medical Sciences
Reference magazines:
Lin, S. Others. (2026) Chinese consensus on diagnosis and treatment of prolactinoma (2025 edition). Chinese Neurosurgical Journal.
DOI: 10.1186/s41016-026-00437-7. https://link.springer.com/article/10.1186/s41016-026-00437-7
