Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia

Objective: To provide practical and up-to-date recommendations for evaluation, differential diagnosis, and treatment of prolactinoma and hyperprolactinemia in various clinical settings. Participants: Members of the Neuroendocrinology Working Group of the Spanish Society of Endocrinology. Methods: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system (GRADE) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (Pubmed) for each subject, and authors' considerations were added in areas where the literature provided scarce evidence. Finally, recommendations were jointly discussed by the Working Group. Conclusions: The document provides evidence-based practical and updated recommendations for diagnosis and management of hyperprolactinemia and prolactinoma, including drug-induced hyperprolactinemia, treatment options for prolactinoma (drugs, surgery, and radiotherapy), prolactinoma in pregnancy, adverse effects of dopaminergic agents, and drug-resistant and malignant prolactinomas. (C) 2012 SEEN. Published by Elsevier Espana, S.L. All rights reserved.