Hyperlactinemia is the most commonplace expression of hypophyseal pathology, above all in females, and is one of the most frequent causes of sexual disorders. The present study examined the etiopathogenesis of hyperprolactinemic syndromes and discusses their pathophysiology, paying special attention to neuroendocrine alterations in the presence of either prolactin-secreting adenoma or other forms of hyperprolactinemia. Their clinical manifestations are then described together with a detailed review of therapies, especially for prolactinoma. Both general opinion and the authors' personal point of view are reported regarding the indications for medical and surgical treatment for micro and macro-prolactinomas. Lastly, particular aspects are taken into consideration, such as the relationship between hyperprolactinemia and pregnancy, in the light of the most recent findings on the natural evolution of prolactinemia and the possibility of treatment using dopaminergic drugs.