Evidence map›Paper›PMID 42489804›Full record

ArticlePituitary2026

Disentangling secretory ambiguity and the limitations of classical thresholds in defining prolactinomas.

Maya Harary, Mishek Thapa, Stuart D Harper, Ines Donangelo, Anthony P Heaney, Won Kim, Marvin Bergsneider

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Article in Pituitary, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Maya HararyDepartment of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.
Mishek ThapaDavid Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Stuart D HarperDavid Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Ines DonangeloDivision of Endocrinology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Anthony P HeaneyDivision of Endocrinology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Won KimDepartment of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.
Marvin BergsneiderDepartment of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA. MBergsneider@mednet.ucla.edu.ORCID http://orcid.org/0000-0001-6423-5480

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDifferentiating prolactinomas from non-functional pituitary adenomas (NFPAs) with stalk effect relies on biochemical thresholds that assume a linear relationship between tumor size and prolactin secretion. We applied a pathology-informed Prolactin Secretory Efficiency (PSE) framework to characterize diagnostic overlap between prolactinomas and NFPAs and evaluate the limitations of current prolactin thresholds.

methodsRetrospective study of 425 patients undergoing first-time surgery for pituitary adenomas: 115 pathology-confirmed lactotroph adenomas, 291 NFPAs, and 19 mammosomatotrophs. Patients with clinical or biochemical evidence of ACTH- or GH-secreting tumors were excluded. PSE was calculated as the serum prolactin-to-tumor volume ratio [Formula: see text]). Primary outcomes included PSE-based group separation and diagnostic accuracy of the 200 ng/mL threshold.

resultsWhile no NFPA exceeded 200 ng/mL, 42% of pathology-confirmed macroprolactinomas and 49% of macro-NFPAs fell within the diagnostic grey zone (ULN < prolactin < 200 ng/mL). PSE achieved superior group separation versus raw prolactin, yet a paradox emerged: high-efficiency stalk effect in some NFPAs produced PSE values exceeding those of low-efficiency macroprolactinomas.

conclusionsRigid biochemical thresholds fail to capture the full spectrum of lactotroph adenoma biology. Significant secretory ambiguity exists for macroadenomas below 200 ng/mL, creating risk of misclassification. D2-agonist trials may serve as a low-risk diagnostic probe in this grey zone, ensuring low-efficiency prolactinomas receive appropriate first-line medical management.

Indexed as

Pituitary NeoplasmsProlactinomaAdenomaAdultFemaleHumansMaleMiddle AgedProlactinRetrospective StudiesProlactinDiagnostic thresholdNon-functioning adenomaPitNETPituitary adenomaPituitary surgeryProlactinoma

Identifiers

PMID42489804

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.