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Prolactinomas are the most common functioning pituitary adenomas and can present with a broad spectrum of manifestations. As pituitary adenomas grow insidiously and often result in nonspecific symptoms, diagnostic delay is common. The duration of symptoms first reported by the patient to diagnosis can vary greatly, from patients being diagnosed within one year to over 40 years after symptom onset. Early detection of pituitary adenomas is essential to avoid the accumulation of both hyperprolactinemia and mass effect manifestations, such as visual field loss, infertility, and fatigue among others. Worsening of such manifestations in prolactinomas specifically has an inevitable impact on physical and mental health, comorbid conditions, and quality of life (QOL). Here, we review the literature regarding the prevalence, pathophysiology, and clinical evaluation of presenting manifestations of prolactinomas, discuss contributory factors to diagnostic delay and methods to facilitate earlier identification.