Prolactinoma assessment and management: an international multidisciplinary cross-sectional survey of current practice

Abstract Purpose Prolactinomas are the commonest pituitary adenoma encountered in clinical practice, yet many aspects of their assessment and management remain variable. The 2023 Pituitary Society Consensus Statement on the diagnosis and management of prolactin-secreting pituitary adenomas provided important contemporary guidance, but the extent to which current practice aligns with these recommendations remains unclear. We aimed to define international multidisciplinary perspectives on resource availability and clinical decision-making in prolactinoma care. Methods We conducted an international cross-sectional survey of endocrinologists and neurosurgeons involved in prolactinoma management. Questions examined access to clinical resources, awareness of emerging issues in prolactinoma care, and areas of concordance or discordance between reported practice and published guidance. Results A total of 249 clinicians completed the survey, including 210 endocrinologists and 39 neurosurgeons, from America, Europe, Oceania and Asia. Important resource limitations included inconsistent reporting of Knosp grade and limited availability of transcription factor immunohistochemistry. Only 20% of respondents routinely referred newly diagnosed prolactinoma cases for multidisciplinary team discussion. Most endocrinologists counselled patients regarding dopamine agonist-related risks. Amongst neurosurgeons, reported indications for surgery and views on dopamine agonist-induced tumour fibrosis varied considerably. Although current guidelines support surgery as an equal first-line option in selected microadenomas, cabergoline remained the preferred initial treatment in these scenarios. Conclusion International prolactinoma practice is heterogeneous and often discordant with contemporary guidance. Most notably, cabergoline therapy remains the preferred treatment strategy in microprolactinomas, and multidisciplinary discussion of prolactinoma cases is infrequent. This survey dataset serves as a roadmap for future research and clinical service improvement in prolactinoma care globally.