Clinical manifestations, diagnostic evaluation, and therapeutic management of prolactinoma: A review of the literature (2020-2025)

Research objective: The aim of this study is to present current knowledge on prolactinomas, focusing on their clinical manifestations, diagnostic evaluation, and therapeutic management based on literature published between 2020 and 2025. Methodology: The study is based on a narrative review of recent scientific literature concerning prolactinomas, with particular attention to clinical presentation, diagnostic procedures, treatment strategies, and emerging approaches to individualized patient management. Main conclusions: Prolactinomas are the most common functioning pituitary neuroendocrine tumors and represent a frequent cause of hyperprolactinemia, leading to reproductive, metabolic, and neurological complications. Clinical presentation varies depending on sex, age, and tumor size, with women more frequently presenting with reproductive dysfunction and men often diagnosed later with larger and more invasive tumors. Diagnosis relies on serum prolactin measurement, exclusion of secondary causes of hyperprolactinemia, and pituitary magnetic resonance imaging to assess tumor characteristics. Dopamine agonists, particularly cabergoline, remain the first-line treatment due to their high effectiveness in normalizing prolactin levels and reducing tumor size, while surgery and radiotherapy are reserved for selected cases such as drug resistance or aggressive tumor behavior. Application of the study: The findings may support clinicians in improving diagnostic accuracy and optimizing treatment strategies for patients with prolactinomas, particularly through a more individualized approach to patient management. Originality/Novelty of the study: The review integrates recent findings from studies published between 2020 and 2025, highlighting advances in understanding the clinical heterogeneity of prolactinomas, predictors of treatment response, and emerging perspectives on personalized management and early surgical intervention.