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Balen AH, Tamblyn J, Skorupskaite K, Munro MG. A comprehensive review of the new FIGO classification of ovulatory disorders. Hum Reprod Update 2024; 30:355-382. [PMID: 38412452 DOI: 10.1093/humupd/dmae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO). OBJECTIVE AND RATIONALE This review outlines in detail each component of the FIGO HyPO-P (hypothalamic, pituitary, ovarian, PCOS) classification with a concise description of each cause, and thereby provides a systematic method for diagnosis and management. SEARCH METHODS We searched the published articles in the PubMed database in the English-language literature until October 2022, containing the keywords ovulatory disorders; ovulatory dysfunction; anovulation, and each subheading in the FIGO HyPO-P classification. We did not include abstracts or conference proceedings because the data are usually difficult to assess. OUTCOMES We present the most comprehensive review of all disorders of ovulation, published systematically according to the logical FIGO classification. WIDER IMPLICATIONS Improving the diagnosis of an individual's ovulatory dysfunction will significantly impact clinical practice by enabling healthcare practitioners to make a precise diagnosis and plan appropriate management.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | - Jennifer Tamblyn
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, The University of California, Los Angeles, Los Angeles, CA, USA
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Yıldız Y, Kuseyri Hübschmann O, Akgöz Karaosmanoğlu A, Manti F, Karaca M, Schwartz IVD, Pons R, López-Laso E, Palacios NAJ, Porta F, Kavecan I, Balcı MC, Dy-Hollins ME, Wong SN, Oppebøen M, Medeiros LS, de Paula LCP, García-Cazorla A, Hoffmann GF, Jeltsch K, Leuzzi V, Gökçay G, Hübschmann D, Harting I, Özön ZA, Sivri S, Opladen T. Levodopa-refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism. J Inherit Metab Dis 2024; 47:431-446. [PMID: 37452721 DOI: 10.1002/jimd.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism.
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Affiliation(s)
- Yılmaz Yıldız
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | | | - Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ida Vanessa D Schwartz
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Natalia Alexandra Julia Palacios
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Ivana Kavecan
- Faculty of Medicine, University of Novi Sad, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Mehmet Cihan Balcı
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suet-Na Wong
- Department of Pediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Mari Oppebøen
- Division of Child Neurology, Children's Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Leonardo Simão Medeiros
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Angeles García-Cazorla
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Gülden Gökçay
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Daniel Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Z Alev Özön
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
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Szukiewicz D. Current Insights in Prolactin Signaling and Ovulatory Function. Int J Mol Sci 2024; 25:1976. [PMID: 38396659 PMCID: PMC10889014 DOI: 10.3390/ijms25041976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Prolactin (PRL) is a pleiotropic hormone released from lactotrophic cells of the anterior pituitary gland that also originates from extrapituitary sources and plays an important role in regulating lactation in mammals, as well as other actions. Acting in an endocrine and paracrine/autocrine manner, PRL regulates the hypothalamic-pituitary-ovarian axis, thus influencing the maturation of ovarian follicles and ovulation. This review provides a detailed discussion of the current knowledge on the role of PRL in the context of ovulation and ovulatory disorders, particularly with regard to hyperprolactinemia, which is one of the most common causes of infertility in women. Much attention has been given to the PRL structure and the PRL receptor (PRLR), as well as the diverse functions of PRLR signaling under normal and pathological conditions. The hormonal regulation of the menstrual cycle in connection with folliculogenesis and ovulation, as well as the current classifications of ovulation disorders, are also described. Finally, the state of knowledge regarding the importance of TIDA (tuberoinfundibular dopamine), KNDγ (kisspeptin/neurokinin B/dynorphin), and GnRH (gonadotropin-releasing hormone) neurons in PRL- and kisspeptin (KP)-dependent regulation of the hypothalamic-pituitary-gonadal (HPG) axis in women is reviewed. Based on this review, a rationale for influencing PRL signaling pathways in therapeutic activities accompanying ovulation disorders is presented.
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Affiliation(s)
- Dariusz Szukiewicz
- Department of Biophysics, Physiology & Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland
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Liu H, Zhang X, Chen W, Xu Y, Lin X, Lin A. The relationship between plasma prolactin levels and clinical manifestations with neuromyelitis optica spectrum disorders. Neurol Sci 2024; 45:699-707. [PMID: 37620730 DOI: 10.1007/s10072-023-07008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Systemic prolactin levels have been found to increase in 19 patients diagnosed with neuromyelitis optica spectrum disorders (NMOSD). However, the relationship between plasma prolactin levels and clinical manifestations in NMOSD patients remains unclear. METHODS This cross-sectional study was conducted as part of a Registered Cohort Study of Inflammatory Demyelination Disease (NCT04386018). A total of 95 patients diagnosed with central nervous system demyelinating diseases and 43 healthy controls were recruited between May 2020 and February 2022 at the First Affiliated Hospital of Fujian Medical University. Plasma samples were collected from all participants and analyzed for prolactin levels using electrochemiluminescence immunoassay. The study aimed to investigate the correlation between plasma prolactin levels and clinical features in patients with central nervous system demyelinating diseases. RESULTS Plasma prolactin levels in NMOSD patients were significantly higher than those in multiple sclerosis/myelin oligodendrocyte glycoprotein antibody-associated diseases patients and controls (p<0.05, respectively), and were found to be correlated with disease activity, sensory abnormalities, thoracic spinal cord lesions, and MR lesion enhancement (p<0.05). A total of 16.28% of NMOSD patients exhibited macroprolactinemia. However, there was no correlation found between macroprolactin levels and disease activity (p>0.05). CONCLUSION Prolactin may play a role in the pro-inflammatory regulation mechanism of NMOSD.
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Affiliation(s)
- Hanchen Liu
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xianxing Zhang
- Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350212, Fujian, China
| | - Wei Chen
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, 350004, Fujian, China
- Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350212, Fujian, China
| | - Yiwen Xu
- Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Xiaoting Lin
- Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China
| | - Aiyu Lin
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, 350004, Fujian, China.
- Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China.
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350212, Fujian, China.
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García Cano AM, Jiménez Mendiguchía L, Rosillo Coronado M, Gómez Lozano A, Del Rey-Mejías ÁL, Fresco Merino M, Marchán Pinedo M, Araujo-Castro M. Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management. ENDOCRINOL DIAB NUTR 2022; 69:771-778. [PMID: 36526352 DOI: 10.1016/j.endien.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE To analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. PATIENTS AND METHODS A retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. RESULTS In 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. CONCLUSION Hyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.
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Affiliation(s)
- Ana M García Cano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain.
| | | | | | - Ana Gómez Lozano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain
| | | | - María Fresco Merino
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain
| | - Marta Marchán Pinedo
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal Madrid, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal Madrid, Spain; Department of Health Science, Universidad Alcalá, Madrid, Spain; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
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Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rodier C, Courbière B, Fernandes S, Vermalle M, Florence B, Resseguier N, Brue T, Cuny T. Metoclopramide Test in Hyperprolactinemic Women With Polycystic Ovarian Syndrome: Old Wine Into New Bottles? Front Endocrinol (Lausanne) 2022; 13:832361. [PMID: 35250884 PMCID: PMC8895271 DOI: 10.3389/fendo.2022.832361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.
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Affiliation(s)
- Claire Rodier
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Blandine Courbière
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
| | - Sara Fernandes
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Marie Vermalle
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Bretelle Florence
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Noémie Resseguier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
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Biagetti B, Ferrer Costa R, Alfayate Guerra R, Álvarez García E, Berlanga Escalera E, Casals G, Esteban Salán M, Granada Ibern ML, Gorrín Ramos J, López Lazareno N, Oriola J, Sánchez Martínez PM, Torregrosa Quesada ME, Urgell Rull E, García Lacalle C. Macroprolactin: From laboratory to clinical practice. ENDOCRINOL DIAB NUTR 2022; 69:63-69. [PMID: 35232561 DOI: 10.1016/j.endien.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 06/14/2023]
Abstract
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
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Affiliation(s)
- Betina Biagetti
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Roser Ferrer Costa
- Servei de Bioquímica, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Rocío Alfayate Guerra
- Laboratorio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, Spain
| | - Elías Álvarez García
- Servicio de Análisis Clínicos, Hospital do Meixoeiro, CHU de Vigo, Vigo, Pontevedra, Spain
| | | | - Gregori Casals
- Servicio de Bioquímica i Genética Molecular, Hospital Clínic Universitari, IDIBAPS, Barcelona, Spain
| | | | - María-Luisa Granada Ibern
- Servicio de Bioquímica Clínica, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Jorge Gorrín Ramos
- Servicio de Boquímica, Laboratorio de Hormonas y Biomarcadores, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves López Lazareno
- Servicio de Boquímica, Laboratorio de Hormonas y Biomarcadores, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josep Oriola
- Servicio de Bioquímica i Genética Molecular, Hospital Clínic Universitari, IDIBAPS, Barcelona, Spain
| | | | - M Eugenia Torregrosa Quesada
- Servicio de Análisis Clínicos, Laboratorio de Hormonas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eulàlia Urgell Rull
- Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Alvarez-Payares JC, Bello-Simanca JD, De La Peña-Arrieta EDJ, Agamez-Gomez JE, Garcia-Rueda JE, Rodriguez-Arrieta A, Rodriguez-Arrieta LA. Common Pitfalls in the Interpretation of Endocrine Tests. Front Endocrinol (Lausanne) 2021; 12:727628. [PMID: 34557164 PMCID: PMC8453144 DOI: 10.3389/fendo.2021.727628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/23/2021] [Indexed: 11/15/2022] Open
Abstract
Endocrine tests are the cornerstone of diagnosing multiple diseases that primary care physicians are frequently faced with. Some of these tests can be affected by situations that affect the proper interpretation, leading to incorrect diagnoses and unnecessary treatment, such as the interference of biotin with thyroid function test, falsely elevated prolactin values in presence of macroprolactinemia or falsely normal due to the "hook effect" in macroprolactinomas. Recognizing these situations is essential for the clinician to make an adequate interpretation of these tests as well as an accurate diagnosis that guarantees the best outcomes for the patient.
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Affiliation(s)
- Jose C. Alvarez-Payares
- Internal Medicine Department, Faculty of Medicine, University of Antioquia, Medellin, Colombia
- Internal Medicine Service, Institución Prestadora de Servicios (IPS) Universitaria - Clínica León XIII, Medellin, Colombia
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Yang W, Guo Z, Zhou Y, Du J, Liu H, Jia J, Shen Y, Chen Y. Optimization of a Screening Method for Macroprolactinemia. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1175:122723. [PMID: 33989987 DOI: 10.1016/j.jchromb.2021.122723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To optimize a screening method for macroprolactinemia and improve the accuracy of free prolactin (freePRL) detection. METHOD Overall efficiency, calculated as the product of the immunoglobulin G (IgG) precipitation rate and the freePRL recovery rate were employed to determine the concentration of the precipitant polyethylene glycol (PEG). Then, an optimized screening method for macroprolactinemia was established. The concentrations of freePRL, obtained by gel filtration chromatography (GFC), from 66 cases were used as the gold standard, and the sensitivity, specificity, accuracy and precision of the optimized and traditional methods for detecting macroprolactinemia were compared. RESULTS (1) The IgG precipitation rate increased with increasing PEG6000 concentration, and the freePRL recovery rate decreased with increasing PEG6000 concentration; the overall efficiency first increased and then decreased. When the IgG concentrations in the mixture were 10 g/L, 25 g/L and 40 g/L, the concentrations of PEG6000 with the highest overall efficiency were 24%, 20% and 18%, respectively. (2) The effect of high and low IgG on the overall efficiency was 4.7% when using 20% PEG6000, which was lower than the effects when using 18% or 24% PEG6000 (9.2% and 13.2%). (3) In the optimized method established using 20% PEG6000, the macroprolactin (macroPRL) chromatographic peak disappeared, but the freePRL chromatographic peak was retained. The sensitivity of this macroprolactinemia screening method was 96.7%, and the specificity was 100%. (4) The freePRL concentrations obtained by the optimized method for samples from 30 macroprolactinemia cases and 36 true hyperprolactinemia cases were 15.8 (10.2-21.4) ng/mL and 60.2 (51.8-79.9) ng/mL; the concentrations were similar to those obtained using the GFC method (16.3 (11.9-27.2) ng/mL and 68.1 (49.5-92.9) ng/mL, respectively (p > 0.05)) and higher than those obtained using the traditional method (9.1 (6.1-17.6) ng/mL and 51.4 (43.7-71.9) ng/mL), respectively, p < 0.05)). (5) The relative deviation between the optimized and GFC methods was -7.0%, which was significantly lower than the relative deviation between the traditional and GFC methods (-21.4%, p < 0.01). (6) The in-batch coefficients of variation (CVs) for the dual-level quality control materials measured by the optimized method were 1.88% and 1.87%, and the within-laboratory CVs were 2.55% and 2.29%, which were slightly lower than the in-batch CVs (1.93% and 2.81%) and within-laboratory CVs (2.75% and 2.81%) measured by the traditional method. CONCLUSION The established optimized method for screening macroprolactinemia using 20% PEG6000 as a precipitant can completely precipitate macroPRL components and effectively retain freePRL components. Compared with traditional methods, the optimized method is simpler, more accurate and more stable for the quantitative detection of freePRL.
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Affiliation(s)
- Wei Yang
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Zhen Guo
- Department of Clinical Laboratory, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Yanping Zhou
- Dean Genetic Engineering Co., Ltd, Hangzhou, 310014, China
| | - Jing Du
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Huibin Liu
- Department of Clinical Laboratory, Fuyuan Hospital of Yiwu, Jinhua, 321000, China
| | - Jingnian Jia
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Yuhuan Shen
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.
| | - Yongjian Chen
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.
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Biagetti B, Ferrer Costa R, Alfayate Guerra R, Álvarez García E, Berlanga Escalera E, Casals G, Esteban Salán M, Granada Ibern ML, Gorrín Ramos J, López Lazareno N, Oriola J, Sánchez Martínez PM, Torregrosa Quesada ME, Urgell Rull E, García Lacalle C. Macroprolactin: From laboratory to clinical practice. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00082-3. [PMID: 33903089 DOI: 10.1016/j.endinu.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 01/25/2023]
Abstract
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
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Affiliation(s)
- Betina Biagetti
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Roser Ferrer Costa
- Servei de Bioquímica, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Rocío Alfayate Guerra
- Laboratorio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, España
| | - Elías Álvarez García
- Servicio de Análisis Clínicos, Hospital do Meixoeiro, CHU de Vigo, Vigo, Pontevedra, España
| | | | - Gregori Casals
- Servicio de Bioquímica i Genética Molecular, Hospital Clínic Universitari, IDIBAPS, Barcelona, España
| | | | - María-Luisa Granada Ibern
- Servicio de Bioquímica Clínica, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Jorge Gorrín Ramos
- Servicio de Boquímica, Laboratorio de Hormonas y Biomarcadores, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Nieves López Lazareno
- Servicio de Boquímica, Laboratorio de Hormonas y Biomarcadores, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Josep Oriola
- Servicio de Bioquímica i Genética Molecular, Hospital Clínic Universitari, IDIBAPS, Barcelona, España
| | | | - M Eugenia Torregrosa Quesada
- Servicio de Análisis Clínicos, Laboratorio de Hormonas, Hospital General Universitario de Alicante, Alicante, España
| | - Eulàlia Urgell Rull
- Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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12
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Yu C, Fan F, Hu S, Meng L, Xu D, Wang J, Chen L, Liu J, Dong Y, Lu Y, Shen M, Zhai Y, Cao Z. Evaluation of autoantibodies and immunoglobulin G subclasses in women with suspected macroprolactinemia. J Clin Lab Anal 2020; 34:e23456. [PMID: 32597541 PMCID: PMC7676205 DOI: 10.1002/jcla.23456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Macroprolactin mostly composed of an immunoglobulin G (IgG) and a monomeric prolactin (PRL) represents the major circulating PRL form in the patients with macroprolactinemia that are usually asymptomatic and may not require treatment. In this study, we aimed to evaluate the prevalence of antithyroid and antinuclear antibodies, as well as the IgG subclass distributions in the patients suspected for macroprolactinemia. METHODS From January to July in 2018, totally 317 patients with elevated PRL were subjected to the polyethylene glycol (PEG) precipitation assay. The patients with recovery rates of ≤60% were subjected for IgG subclass determination and autoantibody testing including thyroid peroxidase antibody (aTPO), antithyroglobulin antibody (aTG), and antinuclear antibodies (ANA). RESULTS The higher the post-PEG PRL recovery rates, the less typical hyperprolactinemia symptoms and the higher prevalence of autoantibodies were observed. The IgG1 and IgG3 were the predominant subclasses in the PRL-IgG complexes according to the immunoprecipitation experiments. CONCLUSION The patients with post-PEG PRL recovery rates of <40% and 40%-60% were likely to represent two distinct populations of different clinical presentations. The prevalence of autoantibodies and IgG subclasses distribution suggested their pathogenic significance in the development of macroprolactinemia.
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Affiliation(s)
- Chao Yu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Fei Fan
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Siqi Hu
- Institute of Pathogen Biology, and Center for AIDS Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingxin Meng
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dong Xu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Juan Wang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lu Chen
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jingrui Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying Dong
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yifan Lu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Min Shen
- Reference Laboratory, MedicalSystem Biotechnology Co., Ltd, Ningbo, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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McKeeman GC, Hall SL, Freedman DB. Reflex and reflective testing practice in Clinical Biochemistry in the United Kingdom – a national survey. Ann Clin Biochem 2019; 57:77-87. [DOI: 10.1177/0004563219888541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background/aims The addition of further tests to patient samples, whether by reflex (automated) methods or reflectively after result review, remains an important function of the diagnostic laboratory. This can assist clinicians with interpretation of results and aid further management. We aimed to investigate how this is performed within Clinical Biochemistry laboratories across the United Kingdom (UK). Methods A questionnaire, consisting of 16 clinical scenarios, was circulated to Clinical Biochemistry laboratories across the UK via the Association for Clinical Biochemistry and Laboratory Medicine (ACB) office. The survey sought to examine opinion on what tests are considered reflex and reflective, which staff members are involved in addition of further tests, whether clinicians are contacted and how abnormal results are handled. Results Responses were received from 74 laboratories, and data were compiled for each scenario surveyed. The majority of laboratories are adding calcium and magnesium, reflectively, to confirm hyperkalaemia or hypocalcaemia, and a number of additional endocrine tests are also commonly performed in particular scenarios. However, there are variations in what is regarded as reflex and reflective testing, in how this testing is conducted within the laboratory and in the level of communication with the requesting clinician. Discussion We present the consensus views of the survey participants for a number of commonly used additional tests within Clinical Biochemistry and a discussion on current reflex and reflective testing practice based on the survey results and evidence, where it exists. There is a need for harmonization and national guidance in this area.
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Affiliation(s)
- Gareth C McKeeman
- Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, UK
| | - Sally L Hall
- Department of Clinical Biochemistry, Luton and Dunstable University Hospital, Luton, UK
| | - Danielle B Freedman
- Department of Clinical Biochemistry, Luton and Dunstable University Hospital, Luton, UK
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Espinós JJ, Vanrell C, Gich I, Urgell E, Calaf J. Pituitary response profile following metoclopramide administration in women with different forms of hyperprolactinemia. Gynecol Endocrinol 2017; 33:148-151. [PMID: 27841032 DOI: 10.1080/09513590.2016.1222363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIMS To test the hypothesis that macroprolactinemia is an extra-pituitary phenomenon by showing that the pituitary production of prolactin in patients with hyperprolactinemia due to macroprolactin is comparable to that in normoprolactinemic women and different from that in women with monomeric hyperprolactinemia. METHODS Twenty-five women were studied: eight with macroprolactin hyperprolactinemia, eight with monomeric hyperprolactinemia, and nine controls. Prolactin levels were measured before and after precipitation with polyethylene glycol at baseline and at 5, 10,15, 30, and 60 min after metoclopramide administration (10 mg i.v.) in the three groups. RESULTS The response profile of total and monomeric prolactin following the administration of metoclopramide was similar in women with monomeric hyperprolactinemia and normoprolactinemia but different in women with macroprolactinemia. The areas under the curve for total and monomeric prolactin were higher in patients with macroprolactinemia than in the other two groups (p < 0·0001). The maximal concentration of monomeric prolactin was reached before that of total prolactin in macroprolactinemic patients but the differences were not significant. DISCUSSION Our findings support the hypothesis that prolactin secretion is comparable in women with macroprolactinemia and in normoprolactinemic women. The dynamics of the secretion suggest that the formation of prolactin complexes is an extra-pituitary process.
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Affiliation(s)
| | | | - Ignasi Gich
- b Department of Clinical Epidemiology and Public Health , and
| | - Eulalia Urgell
- c Department of Biochemistry , Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB) , Barcelona , Spain
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15
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Adra A, El Zibdeh MY, Abdul Malek AMM, Hamrahian AH, Abdelhamid AMS, Colao A, Anastasiades E, Ahmed EMAF, Ezzeddine JI, El Sattar MIA, Dabit ST, Ghanameh W, Nedjatian N, El-Kak F. Differential diagnosis and management of abnormal uterine bleeding due to hyperprolactinemia. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Krysiak R, Drosdzol-Cop A, Skrzypulec-Plinta V, Okopien B. Sexual function and depressive symptoms in young women with elevated macroprolactin content: a pilot study. Endocrine 2016; 53:291-8. [PMID: 26902871 PMCID: PMC4901097 DOI: 10.1007/s12020-016-0898-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/10/2016] [Indexed: 01/13/2023]
Abstract
Elevated prolactin levels seem to be associated with impaired sexuality. The clinical significance of macroprolactinemia, associated with the predominance of high molecular mass circulating forms of prolactin, is still poorly understood. This study was aimed at investigating sexual function in young women with macroprolactinemia. The study enrolled 14 young women with macroprolactinemia, 14 with increased monomeric prolactin levels, as well as 14 age- and weight-matched healthy women. All patients completed a questionnaire evaluating female sexual function (Female Sexual Function Index-FSFI), as well as a questionnaire assessing the presence and severity of depressive symptoms (Beck Depression Inventory Second Edition-BDI-II). Apart from total prolactin levels and macroprolactin content, circulating levels of thyrotropin, total testosterone, and 17-β estradiol were also measured. Patients with elevated monomeric prolactin levels had a lower total FSFI score, as well as lower scores for all domains: sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and dyspareunia. These scores correlated with total and monomeric prolactin levels. In turn, women with macroprolactinemia were characterized by a lower score for sexual desire, and only this score correlated with total prolactin levels and macroprolactin content. The total score in the BDI-II questionnaire was higher in patients with hyper- and macroprolactinemia than in the control subjects. Contrary to multidimensional impairment of sexual function in women with elevated monomeric prolactin, macroprolactinemia only seems to disturb sexual desire.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, ul. Medyków 18, 40-752, Katowice, Poland
| | - Agnieszka Drosdzol-Cop
- Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, ul. Medyków 12, 40-752, Katowice, Poland.
| | - Violetta Skrzypulec-Plinta
- Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, ul. Medyków 12, 40-752, Katowice, Poland
| | - Bogusław Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, ul. Medyków 18, 40-752, Katowice, Poland
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Krysiak R, Kowalska B, Szkróbka W, Okopień B. A neutral effect of testosterone therapy on macroprolactin content in men with macroprolactinemia and late-onset hypogonadism. Pharmacol Rep 2016; 68:139-43. [PMID: 26721365 DOI: 10.1016/j.pharep.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the light of recent studies, macroprolactinemia seems to occur much more frequently than previously thought. In women, oral contraceptive pills exhibit a stimulatory effect on macroprolactin production. No previous study has investigated macroprolactin levels in androgen-treated hypogonadal men. METHODS We studied 10 men with isolated macroprolactinemia and 14 men with normal prolactin levels who because of late-onset hypogonadism were treated with intramuscular testosterone enanthate. Serum prolactin, macroprolactin content, serum testosterone and gonadotropin levels were assessed at baseline and after 4 months of therapy. RESULTS Although baseline levels of testosterone and gonadotropins were similar in men with and without macroprolactinemia, clinical symptoms were more severe in patients with elevated big-big prolactin levels. As expected, testosterone treatment increased serum testosterone, slightly reduced serum gonadotropins, as well as improved clinical condition in both patients with and without macroprolactinemia, with no difference between the groups. However, testosterone therapy did not affect serum prolactin and macroprolactin content, even after replacing intramuscular testosterone enanthate with oral testosterone undecanoate. CONCLUSIONS Our results suggest a negligible effect of testosterone replacement on macroprolactin levels in macroprolactinemic men with late-onset hypogonadism.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
| | - Beata Kowalska
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland; Department of Endocrinology, Provincial Hospital, Opole, Poland
| | - Witold Szkróbka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Makroprolaktinämie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2015. [DOI: 10.1007/s10304-015-0022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guclu M, Cander S, Kiyici S, Vatansever E, Hacihasanoğlu AB, Kisakol G. Serum macroprolactin levels in pregnancy and association with thyroid autoimmunity. BMC Endocr Disord 2015; 15:31. [PMID: 26091810 PMCID: PMC4475296 DOI: 10.1186/s12902-015-0025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022] Open
Abstract
BACGROUND To assess the contribution of macroprolactin to high serum prolactin levels and their association with thyroid status and thyroid autoimmunity during pregnancy. METHODS 138 pregnant women who suspected of having thyroid dysfunction were studied and divided into three groups according to the thyroid status; group 1; euthyroidism (n 40), group 2; hypothyroidism (n 54), and group 3; hyperthyroid (n 44). Polyethylene glycol (PEG) precipitation method was used for detection of macroprolactin. A percentage recovery of 40 % or less is considered as macroprolactinemia. If macroprolactin was negative, the percentage of monomeric prolactin recovery (monoPRL %) after PEG precipitation was used for comparison between the groups. RESULTS Macroprolactinemia was found in two patients (1.4 %) one from hypothyroid and other from euthyroid group. Basal prolactin levels in these patients were 400 and 403 ng/mL respectively. Referring to all patients, there was no correlation between PRL, macroPRL or monoPRL % with thyroid hormone status and also with the serum levels of thyroid antibodies (p > 0.05). A positive correlation was observed between the serum levels of PRL with TSH (p = 0.014 and r = 0.219), while a negative correlation was found with FT4 (p = 0.011 and r = -0.227). CONCLUSIONS Despite the fact that serum prolactin levels were found to be high during pregnancy, the contribution of macroprolactin was found to be insignificant in our study. Unlike other auto immune diseases, we could not find any relationship between thyroid autoimmunity and PRL, macroPRL or monoPRL %. These results confirmed that measured prolactin was quite homogeneous during pregnancy.
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Affiliation(s)
- Metin Guclu
- Department of Endocrinology and Metabolism, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey.
| | - Soner Cander
- Department of Endocrinology and Metabolism, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey
| | - Sinem Kiyici
- Department of Internal Medicine, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey
| | - Ebru Vatansever
- Department of Biochemistry, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey
| | - Arif Bayram Hacihasanoğlu
- Department of Endocrinology and Metabolism, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey
| | - Gurcan Kisakol
- Department of Endocrinology and Metabolism, Sevket Yilmaz Research and Education Hospital, Bursa, Turkey
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