The Endocrine Society has developed clinical practice guidelines for the diagnosis and treatment of hyperprolactinemia. The guidelines aim to provide evidence-based recommendations for assessing the cause of hyperprolactinemia, treating drug-induced hyperprolactinemia, and managing prolactinomas in both nonpregnant and pregnant patients. The guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. The process involved a task force of experts, a methodologist, and a medical writer, with input from various endocrine societies. For diagnosis, a single serum prolactin measurement is recommended, with levels above the upper limit of normal confirming hyperprolactinemia. Dynamic testing is not recommended. In asymptomatic patients, macroprolactin should be assessed. When there is a discrepancy between a large pituitary tumor and a mildly elevated prolactin level, serum samples should be serially diluted to eliminate a potential artifact. For causes of hyperprolactinemia, medication use, renal failure, hypothyroidism, and pituitary or parasellar tumors should be excluded in symptomatic nonphysiological cases. For drug-induced hyperprolactinemia, discontinuation of the medication or substitution with an alternative drug is suggested, followed by remeasurement of serum prolactin. Asymptomatic cases are not recommended for treatment. In cases where the drug cannot be discontinued, a pituitary MRI is recommended to differentiate between medication-induced and symptomatic hyperprolactinemia. For prolactinoma management, dopamine agonist therapy is recommended to lower prolactin levels, reduce tumor size, and restore gonadal function. Cabergoline is preferred over other dopamine agonists. In asymptomatic patients with microprolactinomas, dopamine agonist therapy is not recommended. For resistant or malignant prolactinomas, increasing the dose of dopamine agonists or switching to cabergoline is recommended. Surgery or radiation therapy may be considered for patients who cannot tolerate high doses of cabergoline or are not responsive to dopamine agonist therapy. During pregnancy, dopamine agonist therapy should be discontinued as soon as pregnancy is discovered. Serum prolactin measurements are not recommended during pregnancy. Routine pituitary MRI is not recommended unless there is clinical evidence of tumor growth. For patients with macroprolactinomas, counseling about the potential benefits of surgical resection before attempting pregnancy is recommended. In cases of symptomatic growth of a prolactinoma during pregnancy, bromocriptine therapy is recommended. The guidelines emphasize the importance of individualized treatment based on patient values and preferences, and the need for regular follow-up and monitoring.The Endocrine Society has developed clinical practice guidelines for the diagnosis and treatment of hyperprolactinemia. The guidelines aim to provide evidence-based recommendations for assessing the cause of hyperprolactinemia, treating drug-induced hyperprolactinemia, and managing prolactinomas in both nonpregnant and pregnant patients. The guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of evidence. The process involved a task force of experts, a methodologist, and a medical writer, with input from various endocrine societies. For diagnosis, a single serum prolactin measurement is recommended, with levels above the upper limit of normal confirming hyperprolactinemia. Dynamic testing is not recommended. In asymptomatic patients, macroprolactin should be assessed. When there is a discrepancy between a large pituitary tumor and a mildly elevated prolactin level, serum samples should be serially diluted to eliminate a potential artifact. For causes of hyperprolactinemia, medication use, renal failure, hypothyroidism, and pituitary or parasellar tumors should be excluded in symptomatic nonphysiological cases. For drug-induced hyperprolactinemia, discontinuation of the medication or substitution with an alternative drug is suggested, followed by remeasurement of serum prolactin. Asymptomatic cases are not recommended for treatment. In cases where the drug cannot be discontinued, a pituitary MRI is recommended to differentiate between medication-induced and symptomatic hyperprolactinemia. For prolactinoma management, dopamine agonist therapy is recommended to lower prolactin levels, reduce tumor size, and restore gonadal function. Cabergoline is preferred over other dopamine agonists. In asymptomatic patients with microprolactinomas, dopamine agonist therapy is not recommended. For resistant or malignant prolactinomas, increasing the dose of dopamine agonists or switching to cabergoline is recommended. Surgery or radiation therapy may be considered for patients who cannot tolerate high doses of cabergoline or are not responsive to dopamine agonist therapy. During pregnancy, dopamine agonist therapy should be discontinued as soon as pregnancy is discovered. Serum prolactin measurements are not recommended during pregnancy. Routine pituitary MRI is not recommended unless there is clinical evidence of tumor growth. For patients with macroprolactinomas, counseling about the potential benefits of surgical resection before attempting pregnancy is recommended. In cases of symptomatic growth of a prolactinoma during pregnancy, bromocriptine therapy is recommended. The guidelines emphasize the importance of individualized treatment based on patient values and preferences, and the need for regular follow-up and monitoring.