{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:07:06Z","timestamp":1790071626065,"version":"4.0.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Prolactinomas are the most common functioning pituitary tumors in women of reproductive age and can affect fertility, gonadal and skeletal health, and vision. Management becomes particularly complex when reproductive plans intersect with diagnostic uncertainty, tumor anatomy, pregnancy-related enlargement, and long-term treatment decisions. This focused narrative Mini Review synthesizes current guidelines, consensus statements, systematic reviews, and clinically informative cohort studies and proposes a reproductive-intent-based framework for organizing individualized care. Adequate diagnostic confidence is required before pathway assignment; patients may then enter one of three proposed dynamic management states: fertility-driven, endocrine-stabilization, or surveillance-dominant. Tumor-related risk\u2014including optic-apparatus proximity, documented growth, apoplexy, and clinically important dopamine agonist resistance or intolerance\u2014acts as a cross-cutting safety modifier. Dopamine agonists remain first-line therapy for most patients, with surgery considered for selected anatomically favorable tumors or when medical treatment is ineffective or poorly tolerated. Preconception care aims to restore ovulation and establish anatomical safety; pregnancy surveillance is predominantly symptom-driven; and postpartum reassessment should precede treatment resumption. Persistent hyperprolactinemia alone does not necessarily justify therapy without clinically meaningful hypogonadism, symptoms, or tumor progression. In women not seeking pregnancy, treatment intensity should reflect gonadal status, symptoms, skeletal consequences, and tumor risk. This framework does not replace guideline-based recommendations or constitute a validated clinical classification; rather, it makes management priorities and transitions explicit and requires prospective validation.<\/jats:p>","DOI":"10.3389\/fendo.2026.1946204","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:43:00Z","timestamp":1790070180000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prolactinomas in women of reproductive age: a proposed reproductive-intent-based framework for diagnosis and management"],"prefix":"10.3389","volume":"17","author":[{"given":"Rui","family":"Sun","sequence":"first","affiliation":[{"name":"Fuyong People\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuxu","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yangpu District Shidong Hospital of Shanghai","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shepeng","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yangpu District Shidong Hospital of Shanghai","place":["Shanghai, China"]},{"name":"Shidong Hospital, University of Shanghai for Science and Technology","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-023-00886-5","article-title":"Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement","volume":"19","author":"Petersenn","year":"2023","journal-title":"Nat Rev Endocrinol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1692","article-title":"Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline","volume":"96","author":"Melmed","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"B3","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1210\/er.2005-9998","article-title":"Advances in the treatment of prolactinomas","volume":"27","author":"Gillam","year":"2006","journal-title":"Endocr Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1007\/s12022-022-09703-7","article-title":"Overview of the 2022 WHO classification of pituitary tumors","volume":"33","author":"Asa","year":"2022","journal-title":"Endocr Pathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2605","article-title":"Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas","volume":"95","author":"Ono","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2026.102095","article-title":"Efficacy and long-term outcomes of dopamine agonist treatment in prolactinomas","volume":"40","author":"Rudman","year":"2026","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9343(88)80346-2","article-title":"Pituitary gland growth during normal pregnancy: an in vivo study using magnetic resonance imaging","volume":"85","author":"Gonzalez","year":"1988","journal-title":"Am J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1530\/EJE-21-0145","article-title":"Apoplexy of microprolactinomas during pregnancy: report of five cases and review of the literature","volume":"185","author":"Kuhn","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/EJE-21-0462","article-title":"ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy","volume":"185","author":"Luger","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2026.102081","article-title":"Fertility and pregnancy in patients with prolactinoma","volume":"40","author":"Stumpf","year":"2026","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.2464","article-title":"Cabergoline use and pregnancy outcomes: A systematic review","volume":"117","author":"Otis","year":"2025","journal-title":"Birth Defects Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgae821","article-title":"Disease activity and maternal-fetal outcomes in pregnant women with prolactinoma: A systematic review and meta-analysis","volume":"110","author":"Bandeira","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25031474","article-title":"Effect of hyperprolactinemia on bone metabolism: focusing on osteopenia\/osteoporosis","volume":"25","author":"Yun","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"9801","DOI":"10.1038\/s41598-021-89256-7","article-title":"Identification of an optimal prolactin threshold to determine prolactinoma size using receiver operating characteristic analysis","volume":"11","author":"Leca","year":"2021","journal-title":"Sci Rep"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-024-01469-x","article-title":"Modern approach to bone comorbidity in prolactinoma","volume":"27","author":"Uygur","year":"2024","journal-title":"Pituitary"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-016-0708-3","article-title":"Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when","volume":"19","author":"Dogansen","year":"2016","journal-title":"Pituitary"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcmed.2023.102893","article-title":"Long-term discontinuation of dopamine agonist treatment in patients with prolactinomas revisited","volume":"54","author":"Sosa-Eroza","year":"2023","journal-title":"Arch Med Res"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2026.102085","article-title":"Dopamine agonist withdrawal in patients with prolactinoma","volume":"40","author":"Constantinescu","year":"2026","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2021200203","article-title":"Primary tumors of the pituitary gland: radiologic-pathologic correlation","volume":"41","author":"Shih","year":"2021","journal-title":"Radiographics"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/tomography11090105","article-title":"Rethinking MRI protocols for pituitary microadenomas: prioritizing non-contrast imaging for safe follow-up","volume":"11","author":"Zarei","year":"2025","journal-title":"Tomography"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1055\/a-1468-4608","article-title":"Outcomes of patients with macroprolactinoma desiring pregnancy: follow-up to 23 years from a single center","volume":"53","author":"Tanrikulu","year":"2021","journal-title":"Horm Metab Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13940","article-title":"Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology","volume":"90","author":"Steeds","year":"2019","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-024-01384-1","article-title":"Prolactin-secreting tumors, dopamine agonists and pregnancy: a longitudinal experience of a tertiary neuroendocrine center","volume":"27","author":"Prencipe","year":"2024","journal-title":"Pituitary"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.4103\/ijem.ijem_372_21","article-title":"Prolactinoma outcome after pregnancy and lactation: A cohort study","volume":"25","author":"Laway","year":"2021","journal-title":"Indian J Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-3039","article-title":"Results of a single-center observational 10-year survey study on recurrence of hyperprolactinemia after pregnancy and lactation","volume":"98","author":"Auriemma","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12370","article-title":"Outcome of prolactinoma after pregnancy and lactation: a study on 73 patients","volume":"80","author":"Domingue","year":"2014","journal-title":"Clin Endocrinol (Oxf)"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1946204\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:43:01Z","timestamp":1790070181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1946204\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":26,"alternative-id":["10.3389\/fendo.2026.1946204"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1946204","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1946204"}}