An updated multidisciplinary consensus provides evidence-based recommendations for diagnosing and treating prolactinomas

Prolactinomas are the most common hormone-secreting pituitary tumors, but their diagnosis and management can be challenging because of diverse symptoms and complex treatment decisions. An updated Chinese multidisciplinary consensus integrates the latest clinical evidence and expert experience into 36 recommendations covering screening, diagnosis, imaging, treatment, and follow-up. The guidance promotes individualized care through multidisciplinary collaboration and may help improve long-term outcomes for patients with prolactinomas across diverse healthcare settings and populations.

Prolactinomas are the most common functional pituitary neuroendocrine tumors, accounting for nearly half of all hormone-secreting pituitary adenomas. They can cause a wide range of symptoms, including menstrual disorders, infertility, galactorrhoea, sexual dysfunction, headaches, and visual disturbances. Women of reproductive age are affected most frequently, but the disease can also occur in men, children, and adolescents, in whom delayed diagnosis may lead to larger and more invasive tumors. Over the past decade, advances in surgery, imaging, and medical therapy have transformed clinical practice, creating a need for updated treatment guidance.

Addressing this challenge, a multidisciplinary panel comprising Professor Sheyu Li from the Department of Endocrinology, Sichuan University, China, Professor Huijuan Zhu from the Department of Endocrinology, Chinese Academy of Medical Sciences, China, Dr. Yao Zhao and Dr. Yongfei Wang from the Department of Neurosurgery, Fudan University, China, and Professor Zhe Bao Wu from the Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, China, and the China Pituitary Adenoma Specialist Council collaborated to develop an updated evidence-based consensus on the diagnosis and treatment of prolactinomas. The experts systematically reviewed current evidence and integrated it with clinical experience to establish standardized recommendations for healthcare professionals. This study was published online in Volume 12 of Chinese Neurosurgical Journal on June 8, 2026.

The consensus development process involved 60 specialists from multiple disciplines, including neurosurgery, endocrinology, obstetrics and gynecology, neuroradiology, radiation oncology, and evidence-based medicine. Following internationally recognized guideline frameworks and the GRADE approach, the team identified key clinical questions, reviewed published studies, and finalized 36 recommendations covering screening, assessment, diagnosis, treatment, and long-term monitoring.

One of the key messages is that early recognition can significantly improve patient outcomes. The 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. It also highlights specialized approaches for complex situations, including macroprolactinemia, the Hook effect, hereditary syndromes, and high-risk patients who may benefit from genetic testing.

The recommendations further emphasize the value of advanced imaging. Pituitary magnetic resonance imaging (MRI) remains the preferred diagnostic tool, while dynamic contrast-enhanced MRI may improve the detection of small tumors. The guidance also provides practical advice for imaging follow-up and identifies patients who may require vascular imaging to detect associated intracranial aneurysms before surgery.

“The proposed consensus provides insights into the epidemiological characteristics, clinical manifestations, diagnostic criteria, and treatment strategies for prolactinomas, and recommends individualized management strategies for pregnant women, male patients, and refractory cases,” says Prof. Li. It also promotes a patient-centered multidisciplinary model that brings together specialists from several fields to deliver individualized and precise care.

The impact of the new guidance may extend beyond individual hospitals. Standardized recommendations can facilitate collaboration among clinicians, improve consistency in patient management, and encourage future research on difficult cases such as drug resistance, pregnancy-associated prolactinomas, and hereditary diseases. In the short term, earlier diagnosis and more appropriate treatment selection may reduce complications and preserve fertility and endocrine function. Over the longer term, widespread adoption of evidence-based multidisciplinary care could improve quality of life and long-term outcomes for patients across different healthcare settings.

“This consensus balances clinical needs with international evidence-based standards and provides a highly reliable reference for diagnosis and treatment,” says Prof. Zhu.

Overall, the updated consensus represents a major effort to translate the latest scientific evidence into practical clinical recommendations. By combining multidisciplinary expertise with evidence-based medicine, it provides a framework that may help clinicians deliver more accurate diagnoses, safer treatments, and more personalized care for patients with prolactinomas.

Reference
Lin, S., Chen, Z., Ji, L. et al. Chinese consensus on the diagnosis and treatment of prolactinomas (2025 edition). Chinese Neurosurgical Journal 12, 17 (2026).
https://doi.org/10.1186/s41016-026-00437-7

About Professor Sheyu Li
Dr. Sheyu Li is a Professor at the Department of Endocrinology, Sichuan University, China. He serves as a clinical professor, chief physician, endocrinologist, and evidence-based medicine methodologist at the MAGIC China Centre. His research focuses on living clinical practice guidelines, network meta-analyses, and GRADE methodology for type 2 diabetes, obesity, and related metabolic disorders. Prof. Li has authored 249 publications, received more than 7,400 citations, and actively contributed to evidence-based endocrinology and international collaborative research.

About Professor Huijuan Zhu
Dr. Huijuan Zhu is a Professor at the Department of Endocrinology, Chinese Academy of Medical Sciences, China. Her research spans endocrine and metabolic disorders, with interests including aldosterone biology, metabolomics, body mass index, lipid metabolism, and hormone-related diseases.

About Dr. Yao Zhao
Dr. Yao Zhao is affiliated with the Department of Neurosurgery, Fudan University, China. He specializes in clinical surgery and translational research on brain and pituitary tumors, with particular expertise in minimally invasive pituitary surgery. He leads several national research projects and has published extensively in leading journals, including Nature Genetics, Cell Research, Stroke, and Neurosurgery, receiving multiple prestigious scientific awards.

About Dr. Yongfei Wang
Dr. Yongfei Wang is affiliated with the Department of Neurosurgery, Fudan University, China. His research focuses on pituitary tumors, craniopharyngioma, neurosurgical oncology, and translational medicine. He has long been engaged in the surgical treatment of various craniocerebral tumors, with a primary focus on sellar region tumors. He has accumulated extensive clinical experience in the surgical treatment of pituitary tumors, craniopharyngiomas, and skull base chordomas via transsphenoidal surgery.

About Professor Zhe Bao Wu
Dr. Zhe Bao Wu is a Professor at the Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, China. Prof. Wu has published more than 100 scientific papers in leading journals, including Nature Communications, Acta Neuropathologica, and JCEM. His expertise includes endoscopic minimally invasive surgery of pituitary adenomas, medicine and individualized treatment of pituitary adenomas, and minimally invasive microsurgical treatment of brain tumors.

Funding information
This work was supported by the Key Program of the National Natural Science Foundation of China (grant number: 82541022 and 82573142).