The article presents the diagnosis and treatment guidelines for hyperprolactinemia, a condition characterized by elevated levels of the hormone prolactin. The guidelines are developed by a Task Force appointed by the Endocrine Society, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. The guidelines cover various aspects of hyperprolactinemia, including: 1. **Diagnosis**: A single measurement of serum prolactin is recommended for diagnosis, with dynamic testing not suggested. Asymptomatic patients with high prolactin levels should be assessed for macroprolactin. 2. **Causes**: The Task Force recommends excluding medication use, renal failure, hypothyroidism, and parasellar tumors in symptomatic nonphysiological hyperprolactinemia. 3. **Management of Drug-Induced Hyperprolactinemia**: Discontinuation or substitution of medications is suggested for symptomatic patients, with estrogen or testosterone therapy recommended for long-term hypogonadism. Dopamine agonists are not recommended for asymptomatic patients. 4. **Management of Prolactinoma**: Dopamine agonist therapy is recommended for symptomatic patients with microadenomas or macroadenomas. Cabergoline is preferred due to its higher efficacy. Asymptomatic patients with microadenomas are not treated with dopamine agonists. 5. **Resistant and Malignant Prolactinoma**: For symptomatic patients who do not respond to dopamine agonists, the dose should be increased before considering surgery. Cabergoline is recommended for patients resistant to bromocriptine. Surgery and radiation therapy are suggested for symptomatic patients who cannot tolerate high doses of cabergoline or for those with aggressive or malignant tumors. 6. **Pregnancy Management**: Women with prolactinomas should discontinue dopamine agonist therapy upon discovering pregnancy. Dopaminergic therapy may be continued in selected pregnant patients with macroadenomas. Routine MRI and prolactin measurements are not recommended during pregnancy unless there is clinical evidence of tumor growth. The guidelines aim to provide evidence-based approaches to managing hyperprolactinemia, including assessing the cause, treating drug-induced hyperprolactinemia, and managing prolactinomas in both nonpregnant and pregnant subjects.The article presents the diagnosis and treatment guidelines for hyperprolactinemia, a condition characterized by elevated levels of the hormone prolactin. The guidelines are developed by a Task Force appointed by the Endocrine Society, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. The guidelines cover various aspects of hyperprolactinemia, including: 1. **Diagnosis**: A single measurement of serum prolactin is recommended for diagnosis, with dynamic testing not suggested. Asymptomatic patients with high prolactin levels should be assessed for macroprolactin. 2. **Causes**: The Task Force recommends excluding medication use, renal failure, hypothyroidism, and parasellar tumors in symptomatic nonphysiological hyperprolactinemia. 3. **Management of Drug-Induced Hyperprolactinemia**: Discontinuation or substitution of medications is suggested for symptomatic patients, with estrogen or testosterone therapy recommended for long-term hypogonadism. Dopamine agonists are not recommended for asymptomatic patients. 4. **Management of Prolactinoma**: Dopamine agonist therapy is recommended for symptomatic patients with microadenomas or macroadenomas. Cabergoline is preferred due to its higher efficacy. Asymptomatic patients with microadenomas are not treated with dopamine agonists. 5. **Resistant and Malignant Prolactinoma**: For symptomatic patients who do not respond to dopamine agonists, the dose should be increased before considering surgery. Cabergoline is recommended for patients resistant to bromocriptine. Surgery and radiation therapy are suggested for symptomatic patients who cannot tolerate high doses of cabergoline or for those with aggressive or malignant tumors. 6. **Pregnancy Management**: Women with prolactinomas should discontinue dopamine agonist therapy upon discovering pregnancy. Dopaminergic therapy may be continued in selected pregnant patients with macroadenomas. Routine MRI and prolactin measurements are not recommended during pregnancy unless there is clinical evidence of tumor growth. The guidelines aim to provide evidence-based approaches to managing hyperprolactinemia, including assessing the cause, treating drug-induced hyperprolactinemia, and managing prolactinomas in both nonpregnant and pregnant subjects.