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Khan A, Di Dalmazi G, Najafian Zahmatkeshan K, Caturegli P. Isolated hypoprolactinemia: The rarest of the rare? Rev Endocr Metab Disord 2024:10.1007/s11154-024-09901-0. [PMID: 39271619 DOI: 10.1007/s11154-024-09901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/15/2024]
Abstract
Isolated hypoprolactinemia (IHP) can be defined as the presence of consistently low serum levels of prolactin in the absence of other anterior pituitary hormone abnormalities. It is an extremely rare condition, and consequently incompletely understood and unrecognized. A recent study has reported the first cases of IHP caused by mutation in the PRL gene. There are also cases where the pathogenesis of IHP is likely secondary to an autoimmune response against the PRL-secreting cells. But most published cases are acquired and idiopathic. The best characterized function of PRL is to facilitate milk production in the puerperium. Analysis of the GTEX data repository, however, shows that PRL is the most abundantly expressed gene in the human pituitary, independently of gender and age, suggesting the presence of additional roles for PRL. Newer studies have indeed revealed a much larger spectrum of PRL functions and will likely uncover novel clinical phenotypes associated with severe PRL deficiency.
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Affiliation(s)
- Amna Khan
- School of Medicine, Department of Pathology, Johns Hopkins Hospital, Ross building - Room 656, 720 Rutland Avenue, Baltimore, MD, USA
| | - Giulia Di Dalmazi
- Center for Advanced Studies and Technology (CAST) and Department of Medicine and Aging Science, University "Gabriele d' Annunzio" of Chieti-Pescara, 66100, Chieti, Italy
| | | | - Patrizio Caturegli
- School of Medicine, Department of Pathology, Johns Hopkins Hospital, Ross building - Room 656, 720 Rutland Avenue, Baltimore, MD, USA.
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2
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Smith TP, Kelly S, Fahie-Wilson MN. Cross-reactivity in assays for prolactin and optimum screening policy for macroprolactinaemia. Clin Chem Lab Med 2022; 60:1365-1372. [PMID: 35708266 DOI: 10.1515/cclm-2022-0459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Macroprolactin cross-reacts in immunoassays for prolactin causing apparent hyperprolactinaemia (macroprolactinaemia) and consequent misdiagnosis and mismanagement of patients. METHODS We determined the prevalence of macroprolactinaemia using prolactin immunoassays with reported "high" (Tosoh) or "low" cross-reactivity (Roche) with macroprolactin. We additionally modelled the effects of increasing the screening threshold on workload and sensitivity in the detection of macroprolactinaemia. RESULTS A review of routine requests for prolactin received in a 12 month period identified 670 sera with hyperprolactinaemia (Tosoh assay). Treatment with polyethylene glycol (PEG) precipitation demonstrated normal levels of monomeric prolactin in 165 sera (24.6%) indicating macroprolactinaemia. In the macroprolactinaemic cohort, total prolactin levels were lower with the Roche assay (473 ± 132 mU/L; mean ± SD) compared to the Tosoh assay (683 ± 217 mU/L), p < 0.005. The prevalence of macroprolactinaemia was also lower with the Roche assay (6.2%). The number of samples that required screening for macroprolactinaemia fell by 14% when Roche gender specific total prolactin reference limits were applied. Use of a higher screening threshold (700 mU/L) reduced the screening workload considerably (Roche by 45%, Tosoh by 37%) however, the sensitivity of detection of macroprolactinaemia decreased markedly (Roche 90%, Tosoh 59%). CONCLUSIONS Macroprolactin interferes in both Tosoh and Roche prolactin immunoassays. Use of an assay with a relatively low cross reactivity with macroprolactin, e.g. Roche, will lead to a modest reduction in the screening workload. Increasing the screening threshold above the upper limit of the assay reference interval will also reduce the screening workload but leads to disproportionate increases in the number of cases of macroprolactinaemia which are missed.
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Affiliation(s)
- Thomas P Smith
- Department of Investigative Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
| | - Sinead Kelly
- Department of Investigative Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
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Cozzi R, Ambrosio MR, Attanasio R, Battista C, Bozzao A, Caputo M, Ciccarelli E, De Marinis L, De Menis E, Faustini Fustini M, Grimaldi F, Lania A, Lasio G, Logoluso F, Losa M, Maffei P, Milani D, Poggi M, Zini M, Katznelson L, Luger A, Poiana C. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors. Eur J Endocrinol 2022; 186:P1-P33. [PMID: 35000899 PMCID: PMC8859924 DOI: 10.1530/eje-21-0977] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022]
Abstract
Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century, prolactinomas represented the paradigm of pituitary tumors for which the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.
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Affiliation(s)
- Renato Cozzi
- Division of Endocrinology, Niguarda Hospital, Milan, Italy
- Correspondence should be addressed to R Cozzi;
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Claudia Battista
- Endocrinology Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome, Italy
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano, Florence, Italy
| | | | - Laura De Marinis
- Pituitary Unit, Department of Endocrinology, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy
| | | | | | - Franco Grimaldi
- AME President, Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Endocrinology Unit, Rozzano, Italy
| | - Giovanni Lasio
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University Hospital, Padua, Italy
| | - Davide Milani
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Zini
- Endocrinology Unit, Azienda Ospedaliera S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Catalina Poiana
- ‘Carol Davila’ University of Medicine and Pharmacy – Endocrinology, “C.I. Parhon” National Institute of Endocrinology – Pituitary and Neuroendocrine Disorders, Bucharest, Romania
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4
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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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Rufo E, Martinez-Couselo S, Jimenez-Anon L, Fernandez-Prendes C, Barallat J, Granada ML. Marked geographical variation in the prevalence of macroprolactinemia. Clin Chem Lab Med 2021; 60:71-74. [PMID: 34923782 DOI: 10.1515/cclm-2021-1124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Elena Rufo
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Silvia Martinez-Couselo
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Jimenez-Anon
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Carla Fernandez-Prendes
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Barallat
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria-Luisa Granada
- Department of Clinical Biochemistry, Hospital Universitary Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
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Al Nuaimi A, Almazrouei R, Othman Y, Beshyah S, Aldahmani KM. Prevalence of Macroprolactinemia in Patients with Hyperprolactinemia Using Roche Elecsys Platform in a Large Tertiary Referral Center in UAE. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2021. [DOI: 10.1159/000519094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objectives:</i></b> Macroprolactin (macroPRL) excess is an important cause of hyperprolactinemia. Several prolactin assays have high reactivity to macroPRL. However, macroPRL screening is not routinely performed in many labs. This study aimed to evaluate the prevalence of macroprolactinemia (MP) in patients with elevated prolactin using the Roche Elecsys assay in a large tertiary center in UAE. <b><i>Materials and Methods:</i></b> Consecutive samples of patients with elevated prolactin presenting to Tawam Hospital from June to August 2018 were evaluated for MP. Polyethylene glycol (PEG) was used to precipitate macroPRL. Monomeric prolactin recovery cutoff ≤50% was used to determine the prevalence of MP. <b><i>Results:</i></b> A total of 180 patients with elevated prolactin were included in the study with a mean age of 33.1 ± 11.9 years. The majority were women (87.2%), and about 77.8% were newly diagnosed patients with hyperprolactinemia. The main indications for prolactin testing were menstrual irregularity (<i>n</i> = 121), infertility (<i>n</i> = 11), galactorrhea (<i>n</i> = 11), and sellar masses (<i>n</i> = 12). MP was present in 8.3% of the patients. The median (IQR) of total prolactin level was 740.5 (579–1,085) IU/m before PEG precipitation and was not significantly different between MP and true hyperprolactinemia cases. Three patients with MP had pituitary MRI evaluation, which was normal. Eight patients with MP were treated with cabergoline. <b><i>Conclusion:</i></b> One in 12 patients with hyperprolactinemia had MP on the Roche Elecsys assay defined as the cutoff recovery of ≤50% post-PEG precipitation. Physicians should be aware of the prolactin assay used in their labs, and we recommend routine macroPRL assessment in mild hyperprolactinemia samples in labs using the Roche Elecsys platform.
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Hu Y, Ni J, Zhang B, Cheng W, Zhang H, Ye H, Ji L, Lu B, Guan M. Establishment of reference intervals of monomeric prolactin to identify macroprolactinemia in Chinese patients with increased total prolactin. BMC Endocr Disord 2021; 21:197. [PMID: 34620143 PMCID: PMC8495960 DOI: 10.1186/s12902-021-00861-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Macroprolactin is responsible for pseudohyperprolactinemia and is a common pitfall of the prolactin immunoassay. We aimed to determine the frequency of macroprolactinemia in Chinese hyperprolactinemic patients using monomeric prolactin discriminated by precipitation with polyethylene glycol (PEG). METHODS Post-PEG monomeric prolactin gender-specific reference intervals were established for the Elecsys immunoassay method (Roche Diagnostics) using sera from healthy female (n = 120) and male (n = 120) donors. The reference intervals were validated using 20 macroprolactinemic (as assessed by gel filtration chromatography (GFC)) sera samples, and presence of monomeric prolactin was discriminated by GFC. Patients with high total prolactin were then screened by PEG precipitation to analyze macroprolactin. The demographic and biochemical details of patients with true hyperprolactinemia and macroprolactinemia were compared. RESULTS Reference intervals for monomeric prolactin in females and males were 3.4-18.5 and 2.7-13.1 ng/mL, respectively. Among 1140 hyperprolactinemic patients, macroprolactinemia was identified in 261 (22.9 %) patients while the other 879 (77.1 %) patients were diagnosed with true hyperprolactinemia. Menstrual disturbances were the most common clinical feature in both groups. Galactorrhea, amenorrhea, and visual disturbances occurred more frequently in true hyperprolactinemic patients (P < 0.05). CONCLUSIONS The prevalence of macroprolactin in Chinese patients with hyperprolactinemia was described for the first time. Monomeric prolactin concentration, along with a reference interval screening with PEG precipitation, provides a diagnostic approach for hyperprolactinemia with improved accuracy.
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Affiliation(s)
- Yao Hu
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Jiajin Ni
- Department of Nursing, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Buyue Zhang
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Wei Cheng
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Huating Zhang
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, 200040, Shanghai, China
| | - Lijin Ji
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, 200040, Shanghai, China
| | - Bin Lu
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, 200040, Shanghai, China
| | - Ming Guan
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 200040, Shanghai, China.
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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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Andereggen L, Frey J, Andres RH, Luedi MM, Widmer HR, Beck J, Mariani L, Christ E. Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas. Sci Rep 2021; 11:5122. [PMID: 33664388 PMCID: PMC7933248 DOI: 10.1038/s41598-021-84606-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
While prolactinoma patients have high bone turnover, current data are inconclusive when it comes to determining whether correction of hyperprolactinemia and associated hypogandism improves osteodensitometric data in men and women over the long term. In a large cohort of including 40 men and 60 women, we studied the long-term impact of prolactinoma treatment on bone mineral density (BMD) in men versus women, assessed adverse effects of a primary surgical or medical approach, and evaluated data for risk factors for impaired BMD at last follow-up using multivariate regression analyses. Median duration of follow-up was 79 months (range 13–408 months). Our data indicate that the prevalence of impaired BMD remained significantly higher in men (37%) than in women (7%, p < 0.001), despite the fact that hyperprolactinemia and hypogonadism are under control in the majority of men. We found that persistent hyperprolactinemia and male sex were independent risk factors for long-term bone impairment. Currently, osteoporosis prevention and treatment focus primarily on women, yet special attention to bone loss in men with prolactinomas is advised. Bone impairment as “end organ” reflects the full range of the disease and could become a surrogate marker for the severity of long-lasting hyperprolactinemia and associated hypogonadism.
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Affiliation(s)
- Lukas Andereggen
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Janine Frey
- Department of Endocrinology, Diabetes, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert H Andres
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans Rudolf Widmer
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes and Metabolism, Department of Endocrinology, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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11
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Ruljancic N, Bakliza A, Vuk Pisk S, Geres N, Matic K, Ivezic E, Grosic V, Filipcic I. Antipsychotics-induced hyperprolactinemia and screening for macroprolactin. Biochem Med (Zagreb) 2020; 31:010707. [PMID: 33380894 PMCID: PMC7745162 DOI: 10.11613/bm.2021.010707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction High prolactin (PRL) concentrations are found in laboratory test results of patients on majority of antipsychotic drugs. Prevalence rates and degrees of severity of hyperprolactinemia (HPRL) based on PRL concentration may depend on the presence of macroprolactin in the serum. The aim of the study was to investigate the difference between PRL concentrations before and after precipitation of macroprolactin and to examine if there were any changes in the categorization of HPRL between samples prior and after precipitation. Materials and methods Total of 98 female patients (median age 33; range 19-47 years) diagnosed with a psychotic disorder, proscribed antipsychotic drugs, and with HPRL were included. Total PRL concentration and PRL concentration after macroprolactin precipitation with polyethylene glycol (postPEG-PRL) were determined by the chemiluminometric method on the Beckman Coulter Access2 analyser. Results Total PRL concentrations (median 1471; IQC: 1064-2016 mlU/L) and postPEG-PRL concentrations (median 1453; IQC: 979-1955 mlU/L) were significantly correlated using intraclass correlation coefficient for single measurements (mean estimation 0.96; 95%CI 0.93-0.97) and average measurement (mean estimation 0.98; 95%CI 0.96-0.99), and all investigated female patient had HPRL according to PRL and postPEG-PRL concentration. The median PRL recovery following PEG precipitation was 95; IQC: 90-100%. There was substantial agreement (kappa test = 0.859, 95% CI: 0.764-0.953) between the categories of HPRL severity based on total PRL concentrations and postPEG-PRL concentrations. Conclusion The study demonstrated that HPRL was present in all subjects using the reference interval for total PRL concentration and postPEG-PRL concentration with no significant impact of macroprolactin presence in the serum on the categorization of patients according to severity of HPRL.
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Affiliation(s)
- Nedjeljka Ruljancic
- Department of Laboratory Diagnostics, Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia.,Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia
| | - Ana Bakliza
- Department of Laboratory Diagnostics, Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia
| | - Sandra Vuk Pisk
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Natko Geres
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Katarina Matic
- Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Ena Ivezic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Vladimir Grosic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Igor Filipcic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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12
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Che Soh NAA, Yaacob NM, Omar J, Mohammed Jelani A, Shafii N, Tuan Ismail TS, Wan Azman WN, Ghazali AK. Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218199. [PMID: 33171973 PMCID: PMC7664288 DOI: 10.3390/ijerph17218199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023]
Abstract
Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I2 = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.
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Affiliation(s)
- Noor Azlin Azraini Che Soh
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia;
- Correspondence:
| | - Julia Omar
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Aniza Mohammed Jelani
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Noorazliyana Shafii
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Tuan Salwani Tuan Ismail
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Wan Norlina Wan Azman
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (N.A.A.C.S.); (J.O.); (A.M.J.); (N.S.); (T.S.T.I.); (W.N.W.A.)
| | - Anis Kausar Ghazali
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia;
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13
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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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14
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Chutpiboonwat P, Yenpinyosuk K, Sridama V, Kunjan S, Klaimukh K, Snabboon T. Macroprolactinemia in patients with hyperprolactinemia: an experience from a single tertiary center. Pan Afr Med J 2020; 36:8. [PMID: 32550971 PMCID: PMC7282613 DOI: 10.11604/pamj.2020.36.8.22923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
Macroprolactinemia frequently causes misdiagnosis, unnecessary investigation and inappropriate treatment in hyperprolactinemic patients. Aim of this study is to investigate the prevalence and clinical characteristics of Thai patients with macroprolactinemia. We performed a cross-sectional study in 56 hyperprolactinemic patients (51 women and 5 men) whose sera were subsequently tested for the presence of macroprolactin. Recovery of less than 40% of serum prolactin after polyethylene glycol (PEG) precipitation was indicative of macroprolactinemia. Our study revealed 19.64% (11/56) of patients with hyperprolactinemia were found to have a preponderance of macroprolactin. All patients with macroprolactinemia were women, of which eight of them were initially diagnosed as idiopathic hyperprolactinemia and mistreated with dopamine agonist medications. Interestingly, neuroradiological abnormalities were reported in three patients with macroprolactinemia, 2 cases with prolactinoma and one case with stalk effect hyperprolactinemia. In conclusion, nearly one-fifth of our patients with hyperprolactinemia have macroprolactinemia. This finding suggests that the diagnostic algorithm of all patients with hyperprolactinemia should include the PEG precipitation test as the initial step. Domain: Endocrinology
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Affiliation(s)
- Phronpan Chutpiboonwat
- Department of Medicine, Bangkok Metropolitan Administration Lat Krabang Hospital, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kanchana Yenpinyosuk
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Saint Louis Hospital, Bangkok, Thailand
| | - Vitaya Sridama
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center for Medical Diagnostic Laboratories, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellent Center in Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Supaksorn Kunjan
- Center for Medical Diagnostic Laboratories, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Karuna Klaimukh
- Center for Medical Diagnostic Laboratories, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thiti Snabboon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center for Medical Diagnostic Laboratories, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellent Center in Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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15
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Smith T, Stern E, Tan E, Vacic A, Fahie-Wilson M. Macroprolactinemia Detection by Magnetically Assisted Polyethylene Glycol Precipitation: Potential for Automation. J Appl Lab Med 2020; 5:494-505. [PMID: 32445359 DOI: 10.1093/jalm/jfaa015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Macroprolactin is an immunoglobulin-prolactin complex that is not bioactive in vivo but the prolactin component remains immunoreactive. The complex is a universal source of interference in prolactin immunoassays and commonly results in misdiagnosis of hyperprolactinemia with consequent clinical mismanagement of patients. Removal of macroprolactin by precipitation with polyethylene glycol (PEG) is an effective technique for identifying such patients but unfortunately not universally employed due to the manual nature of the procedure. METHODS We developed a modified PEG precipitation technique using magnetic nanoparticles that we termed Magnetically Assisted PEG Precipitation (MAPP). This procedure was verified against an established PEG precipitation procedure. RESULTS The MAPP procedure we developed was robust, reproducible, and affords the potential for automation of macroprolactin screening in clinical laboratories. Comparisons of prolactin levels obtained following MAPP in sera from patients with either true hyperprolactinemia or macroprolactinemia generated results comparable to that of conventional PEG precipitation. CONCLUSIONS The MAPP technique yields results comparable to those of traditional PEG precipitation. Elimination of the need for centrifugation affords the possibility of automation and hence more widespread adoption of routine PEG screening by clinical laboratories.
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Affiliation(s)
- Thomas Smith
- Department of Endocrinology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | | | | | - Michael Fahie-Wilson
- Department of Clinical Chemistry, Southend Hospital, Westcliff-on-Sea, Essex SSO ORY, UK
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16
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Jabbour R, Ott J, Eppel W, Frigo P. Carotid intima-media thickness in polycystic ovary syndrome and its association with hormone and lipid profiles. PLoS One 2020; 15:e0232299. [PMID: 32330202 PMCID: PMC7182264 DOI: 10.1371/journal.pone.0232299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/11/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Polycystic ovary syndrome (PCOS) has been associated with an increased risk of metabolic disturbances and cardiovascular disease. Intima-media thickness of the common carotid artery (CIMT) represents a valid surrogate marker of early systemic atherosclerosis. This study aimed to investigate if CIMT is increased in PCOS patients compared to healthy controls and if there is an association with hormone and metabolic profiles. Methods In this prospective cross-sectional study, past medical history, anthropometrical measurements and hormonal, lipidemic and glycemic parameters were obtained in 41 PCOS patients and 43 age-matched healthy controls of similar body mass index (BMI) and frequency of smokers. B-mode ultrasound enabled CIMT measurement at the far wall of the left and right common carotid artery. Results Patients with PCOS showed significantly increased CIMT values compared to healthy controls (0.49±0.04mm vs. 0.37±0.04mm respectively, P<0.001). They featured a generally increased cardiovascular risk profile. Correlation analysis showed a positive association between CIMT and the adverse metabolic risk profile. The diagnosis of PCOS was the strongest predictor of CIMT, even after multiple adjustments for BMI, age and smoking status (β = 0.797, P<0.001, R2 = 0.73). A model among oligomenorrhoic patients revealed a relationship between CIMT and the suspected duration of disease (β = 0.373, P = 0.021, R2 = 0.14). Conclusions PCOS patients are likely to feature signs of premature systemic atherosclerosis at a young age. Early exposure to adverse cardiovascular risk factors may possibly have long-term consequences on the vascular system. An early vessel screening might thus already be beneficial in these patients at a younger age.
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Affiliation(s)
- Rhea Jabbour
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Eppel
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Peter Frigo
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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17
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Abstract
Prolactinomas are the most frequently seen pituitary adenomas in clinical practice. A correct biochemical diagnosis of hyperprolactinemia is a prerequisite for further investigation but may be hampered by analytical difficulties as well as a large number of potentially overlapping conditions associated with increased prolactin levels. Suspicion should rise in patients whose symptoms and biochemical results do not match. Assay problems, macroprolactinemia, and high-dose hook effect are discussed as possible reasons for false positive or false negative prolactin levels. Physiological and pathological causes of hyperprolactinemia and their implications for interpreting prolactin results are reviewed.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Erik-Blumenfeld-Platz 27a, 22587, Hamburg, Germany.
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18
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New insights into human prolactin pathophysiology: genomics and beyond. Curr Opin Obstet Gynecol 2019; 31:207-211. [DOI: 10.1097/gco.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Haddad RA, Giacherio D, Barkan AL. Interpretation of common endocrine laboratory tests: technical pitfalls, their mechanisms and practical considerations. Clin Diabetes Endocrinol 2019; 5:12. [PMID: 31367466 PMCID: PMC6657094 DOI: 10.1186/s40842-019-0086-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Pitfalls in hormonal assays are commonly seen in clinical practice and may lead to erroneous clinical impressions and treatments. In this article, we address common laboratory pitfalls encountered during evaluation of patients with real or presumed endocrine disorders including high dose hook effect and falsely normal prolactin in cases of macroprolactinomas, macroprolactinemia and falsely elevated prolactin, macrothyrotropinemia and falsely elevated TSH, heterophile antibodies leading to false elevation of hormonal concentration, biotin interference with different hormonal assays, cross-reactivity of steroid hormones immunoassays, and others. We describe the mechanisms of such laboratory pitfalls, review clinical scenarios in which they might occur, and discuss the ways to resolve such conundrums. The aim of this article is to present a learning material for the endocrine trainees and practitioners.
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Affiliation(s)
- Raad A. Haddad
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical Center, 24 Frank Lloyd Wright, G-1500, Ann Arbor, MI 48106 USA
| | - Donald Giacherio
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI USA
| | - Ariel L. Barkan
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical Center, 24 Frank Lloyd Wright, G-1500, Ann Arbor, MI 48106 USA
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, MI USA
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20
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Muhtaroglu S, Barlak Keti D, Hacıoglu A. Macroprolactin: an overlooked reason of hyperprolactinemia. J LAB MED 2019. [DOI: 10.1515/labmed-2019-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Immunoassays show variability in the detection of macroprolactin. The aim of this study was to detect the frequency of macroprolactinemia in hyperprolactinemic patients and the problems encountered in routine clinical practice.
Methods
The screening of macroprolactinemia was performed by precipitation with polyethylene glycol (PEG) in 900 patient samples with hyperprolactinemia over a period of approximately 6 months. Recovery values of less than 40% and greater than 60% were considered as macroprolactinemia and predominantly monomeric prolactin (PRL), respectively.
Results
A total of 900 (17.9%) of the 5007 PRL results were out of reference range. Thirty-one (3.4%) of the patients had less than 40% recovery after screening of all patients with hyperprolactinemia. However, the macroprolactin test was requested by clinics from only 171 patients and seven of these patients had less than 40% recovery. We also detected predominantly macroprolactin in 24 samples, overlooked in routine practice. The patients with PRL above 100 ng/mL had no macroprolactinemia.
Conclusions
The screening for macroprolactinemia of hyperprolactinemic patients who have <100 ng/mL and also with unexplained hyperprolactinemia should be the first approach before any further research or treatment is initiated. Thus, unnecessary test repetition, investigation and inappropriate treatment can be avoided. Each laboratory should inform clinicians about the frequency of macroprolactinemia.
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21
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Šostarić M, Bokulić A, Marijančević D, Zec I. Optimizing laboratory defined macroprolactin algorithm. Biochem Med (Zagreb) 2019; 29:020706. [PMID: 31223260 PMCID: PMC6559613 DOI: 10.11613/bm.2019.020706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/21/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Macroprolactinaemia is a well-known analytical problem in diagnostics of hyperprolactinaemia usually detected with polyethylene glycol (PEG) precipitation method. Since there is no harmonization in macroprolactin detection and reporting results, this study proposes and evaluates the usefulness of in-house developed algorithm. The aims were to determine the most suitable way of reporting results after PEG treatment and the possibilities of rationalizing the precipitation procedure. MATERIALS AND METHODS This is a retrospective study based on extracted data for 1136 patients. Prolactin concentrations were measured before and after PEG precipitation on Roche cobas e601. Macroprolactinaemia was defined by percentage recovery and post-PEG prolactin concentrations. RESULTS Prevalence of macroprolactinaemia using recovery criteria of ≤ 40%, ≤ 60%, and post-PEG prolactin concentrations was 3.3%, 8.8% and 7.8%, respectively. Raising the cut-off value from the upper limit of the manufacturer's reference interval to 32.9 µg/L does not drastically change detected macroprolactinaemia with recovery criteria. Post-PEG prolactin concentrations showed more than half of the patients with macroprolactinaemia would be overlooked. Regardless of the criteria, a cut-off of 47.0 µg/L would miss most of the macroprolactinaemic patients. Repeated recovery measurements of follow-up patients showed there is a significant difference with mean absolute bias of 9%. CONCLUSIONS Post-PEG prolactin concentration with corresponding reference interval is the most suitable way of reporting results. All samples with prolactin concentration above the upper limit of the manufacturer's reference interval should be submitted to PEG precipitation. Follow-up period could be prolonged since the difference between the recoveries of repeated measurements is not clinically significant.
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Affiliation(s)
- Milica Šostarić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Adriana Bokulić
- Laboratory of Endocrinology, Clinic of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Domagoj Marijančević
- Laboratory of Endocrinology, Clinic of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivana Zec
- Laboratory of Endocrinology, Clinic of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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Chanson P, Maiter D. The epidemiology, diagnosis and treatment of Prolactinomas: The old and the new. Best Pract Res Clin Endocrinol Metab 2019; 33:101290. [PMID: 31326373 DOI: 10.1016/j.beem.2019.101290] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Prevalence and incidence of prolactinomas are approximately 50 per 100,000 and 3-5 new cases/100,000/year. The pathophysiological mechanism of hyperprolactinemia-induced gonadotropic failure involves kisspeptin neurons. Prolactinomas in males are larger, more invasive and less sensitive to dopamine agonists (DAs). Macroprolactin, responsible for pseudohyperprolactinemia is a frequent pitfall of prolactin assay. DAs still represent the primary therapy for most prolactinomas, but neurosurgery has regained interest, due to progress in surgical techniques and a high success rate in microprolactinoma, as well as to some underestimated side effects of long-term DA treatment, such as impulse control disorders or impaired quality of life. Recent data show that the suspected effects of DAs on cardiac valves in patients with prolactinomas are reassuring. Finally, temozolomide has emerged as a valuable treatment for rare cases of aggressive and malignant prolactinomas that do not respond to all other conventional treatments.
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Affiliation(s)
- Philippe Chanson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital de Bicêtre, F-94275, Le Kremlin-Bicêtre, France; UMR-S1185 Université Paris-Sud, Univ Paris-Saclay, F-94276, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale (Inserm) U1185, F-94276, Le Kremlin Bicêtre, France.
| | - Dominique Maiter
- Service d'Endocrinologie et Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Kalsi AK, Halder A, Jain M, Chaturvedi PK, Sharma JB. Prevalence and reproductive manifestations of macroprolactinemia. Endocrine 2019; 63:332-340. [PMID: 30269265 DOI: 10.1007/s12020-018-1770-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Macroprolactinemia is characterized by predominance of macroprolactin molecules in circulation and generally has extra-pituitary origin. Macroprolactin is viewed as biologically inactive, therefore asymptomatic, and thus may not require any treatment or prolonged follow-up. In addition, data on prevalence of macroprolactinemia and its clinical manifestation are also rare. Therefore, the present study was aimed to find out prevalence of macroprolactinemia and its association, if any, with reproductive manifestations. MATERIAL AND METHODS Macroprolactin was measured in 102 hyperprolactinemia cases (>100 ng/ml prolactin level), 135 physiological hyperprolactinemia cases (50 pregnant and 85 lactating females; >100 ng/ml prolactin level) and 24 controls. Poly ethylene glycol (PEG) precipitation method was carried out to screen macroprolactin. Prolactin recovery of <25% was considered overt macroprolactinemia. Detailed clinical data was recorded which included complete medical history, physical examination and hormone measurements besides CT/MRI for pituitary abnormalities. RESULTS Prevalence of macroprolactinemia was 21.57% (22/102) in hyperprolactinemia (prolactin >100 ng/ml). There was no case of macroprolactinemia in physiological hyperprolactinemia, or healthy control females. Reproductive manifestations were present in 72.73% (16/22) macroprolactinemia cases, out of which macroprolactinemia was the sole cause of associated reproductive manifestations in 68.7% (11/16) cases. Reversal of reproductive dysfunction/s was observed in five cases with appropriate treatment for high macroprolactin. CONCLUSION Macroprolactinemia prevalence was found to be 21.5%, out of which 72.73% cases had associated reproductive dysfunctions.
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Affiliation(s)
- Amanpreet Kaur Kalsi
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashutosh Halder
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India.
| | - Manish Jain
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | - P K Chaturvedi
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Binart N, Young J, Chanson P. Prolactin Assays and Regulation of Secretion: Animal and Human Data. PROLACTIN DISORDERS 2019. [DOI: 10.1007/978-3-030-11836-5_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gounden V, Rampursat YD, Jialal I. Secretory tumors of the pituitary gland: a clinical biochemistry perspective. ACTA ACUST UNITED AC 2018; 57:150-164. [DOI: 10.1515/cclm-2018-0552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 07/16/2018] [Indexed: 12/24/2022]
Abstract
Abstract
The pituitary gland is responsible for the production and/or secretion of various hormones that play a vital role in regulating endocrine function within the body. Secretory tumors of the anterior pituitary predominantly, pituitary adenomas, collectively account for 10%–25% of central nervous system tumors requiring surgical treatment. The most common secretory tumors are prolactinomas, which can be diagnosed by basal prolactin levels. Acromegaly can be diagnosed by basal insulin growth-like factor 1 levels and the failure of growth hormone (GH) to suppress during an oral glucose tolerance test. Cushing disease can be diagnosed by demonstrating hypercortisolemia evidenced by increased salivary cortisol levels in the evening, increased urine free cortisol excretion and failure of plasma cortisol to suppress following oral dexamethasone given overnight (1.0 mg). We also discuss the diagnosis of the rarer thyroid-stimulating hormone and gonadotrophin secretory tumors. Morbidity is associated with tumor occurrence, clinical sequelae as well as the related medical, surgical and radiological management. This review focuses on the pathogenesis of secretory tumors of the anterior pituitary with emphasis on molecular mechanisms associated with tumorigenesis and the major role of the clinical chemistry laboratory in diagnosis and management of these tumors.
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Affiliation(s)
- Verena Gounden
- Department of Chemical Pathology , University of KwaZulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital , Durban , South Africa
| | - Yashna D. Rampursat
- Department of Chemical Pathology , University of KwaZulu Natal and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital , Durban , South Africa
| | - Ishwarlal Jialal
- California North-State University, College of Medicine , Elk Grove, CA 95757 , USA
- Director, Section of Clinical Chemistry, VA Medical Center , Sacramento, CA , USA
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Kasum M, Orešković S, Čehić E, Šunj M, Lila A, Ejubović E. Laboratory and clinical significance of macroprolactinemia in women with hyperprolactinemia. Taiwan J Obstet Gynecol 2018; 56:719-724. [PMID: 29241908 DOI: 10.1016/j.tjog.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/30/2022] Open
Abstract
The role of macroprolactinemia in women with hyperprolactinemia is currently controversial and can lead to clinical dilemmas, depending upon the origin of macroprolactin, the presence of hyperprolactinemic symptoms and monomeric prolactin (PRL) levels. Macroprolactinemia is mostly considered an extrapituitary phenomenon of mild and asymptomatic hyperprolactinemia associated with normal concentrations of monomeric PRL and a predominance of macroprolactin confined to the vascular system, which is biologically inactive. Patients can therefore be reassured that macroprolactinemia should be considered a benign clinical condition, resistant to antiprolactinemic drugs, and that no diagnostic investigations or prolonged follow-up should be necessary. However, a significant proportion of macroprolactinemic patients appears to suffer from hyperprolactinemia-related symptoms and radiological pituitary findings commonly associated with true hyperprolactinemia. The symptoms of hyperprolactinemia are correlated to the levels of monomeric PRL excess, which may be explained as coincidental, by dissociation of macroprolactin, or by physiological, pharmacological and pathological causes. The excess of monomeric PRL levels in such cases is of primarily importance and the diagnosis of macroprolactinemia is misleading or inadequate. However, macroprolactinemia of pituitary origin associated with radiological findings of pituitary adenomas may rarely occur with similar hyperprolactinemic manifestations, exclusively due to bioactivity of macroprolactin. Therefore, in such cases with hyperprolactinemic signs and pituitary findings, macroprolactinemia should be considered a pathological biochemical condition of hyperprolactinemia. Accordingly, individualized diagnostic investigations with the introduction of dopamine agonists, or other treatment with prolonged follow-up, should be mandatory. The review analyses the laboratory and clinical significance of macroprolactinemia in hyperprolactinemic women suggesting clinically useful diagnostic and treatment strategies.
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Affiliation(s)
- Miro Kasum
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | - Slavko Orešković
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ermin Čehić
- Department of Obstetrics and Gynecology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Martina Šunj
- Department of Obstetrics and Gynecology, Clinical Hospital Center Firule, School of Medicine, Split, Croatia
| | - Albert Lila
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Emina Ejubović
- Department of Obstetrics and Gynecology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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Barth JH, Lippiatt CM, Gibbons SG, Desborough RA. Observational studies on macroprolactin in a routine clinical laboratory. ACTA ACUST UNITED AC 2018; 56:1259-1262. [DOI: 10.1515/cclm-2018-0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
It is now recommended that all samples with raised prolactin should be examined for the presence of macroprolactin. We performed a retrospective review of our experience of macroprolactin to determine the incidence and the natural history of macroprolactin.
Methods:
A retrospective study of macroprolactin was made in a large clinical laboratory. Macroprolactin was measured on those samples where it is requested and where the total prolactin is >1000 mIU/L. Prolactin was measured using the Siemens Centaur and macroprolactin was measured following polyethylene glycol (PEG)-precipitation.
Results:
The incidence of macroprolactin in samples where the total prolactin was >1000 mIU/L was 36/670 (5.4%). During this period, 12,064 samples were received for prolactin analysis. Over the period since 2006, 22 subjects had a sample with an isolated macroprolactin measurement followed by another sample without macroprolactin after a median period of 0.46 years. Twenty-five subjects had multiple consecutive measurements of macroprolactin lasting a median period of 2.1 years. Fourteen subjects had more than six samples which had been subjected to PEG precipitation. In these subjects, the reproducibility of PEG precipitation over a median of 6 years was 1.1% CV (recovery 75% [26–110] (median [range])).
Conclusions:
The presence of macroprolactin can change over time and we cannot advise that once a test for macroprolactinemia has been performed that it is not necessary to repeat the investigation if a subsequent sample is hyperprolactinemic; nor can one assume that macroprolactin will not develop even if it has been excluded previously.
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Hyperprolactinemia-inducing antipsychotics increase breast cancer risk by activating JAK-STAT5 in precancerous lesions. Breast Cancer Res 2018; 20:42. [PMID: 29778097 PMCID: PMC5960176 DOI: 10.1186/s13058-018-0969-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/11/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Psychiatric medications are widely prescribed in the USA. Many antipsychotics cause serum hyperprolactinemia as an adverse side effect; prolactin-Janus kinase 2 (JAK2)-signal transducer and activator of transcription 5 (STAT5) signaling both induces cell differentiation and suppresses apoptosis. It is controversial whether these antipsychotics increase breast cancer risk. METHODS We investigated the impact of several antipsychotics on mammary tumorigenesis initiated by retrovirus-mediated delivery of either ErbB2 or HRas or by transgenic expression of Wnt-1. RESULTS We found that the two hyperprolactinemia-inducing antipsychotics, risperidone and pimozide, prompted precancerous lesions to progress to cancer while aripiprazole, which did not cause hyperprolactinemia, did not. We observed that risperidone and pimozide (but not aripiprazole) caused precancerous cells to activate STAT5 and suppress apoptosis while exerting no impact on proliferation. Importantly, we demonstrated that these effects of antipsychotics on early lesions required the STAT5 gene function. Furthermore, we showed that only two-week treatment of mice with ruxolitinib, a JAK1/2 inhibitor, blocked STAT5 activation, restored apoptosis, and prevented early lesion progression. CONCLUSIONS Hyperprolactinemia-inducing antipsychotics instigate precancerous cells to progress to cancer via JAK/STAT5 to suppress the apoptosis anticancer barrier, and these cancer-promoting effects can be prevented by prophylactic anti-JAK/STAT5 treatment. This preclinical work exposes a potential breast cancer risk from hyperprolactinemia-inducing antipsychotics in certain patients and suggests a chemoprevention regime that is relatively easy to implement compared to the standard 5-year anti-estrogenic treatment in women who have or likely have already developed precancerous lesions while also requiring hyperprolactinemia-inducing antipsychotics.
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Taieb A, Maha KN, El Abed YH, Beizig AM, Chadli MC, Ach K. Macroprolactinemia and Empty Sella Syndrome. Pan Afr Med J 2017; 27:278. [PMID: 29187947 PMCID: PMC5660913 DOI: 10.11604/pamj.2017.27.278.11361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/02/2017] [Indexed: 01/15/2023] Open
Abstract
Macroprolactinemia is a polymeric form of prolactin-release, causing mildly symptomatic clinical pictures. The former can be isolated or associated with other causes of hyperprolactinemia. The association with an empty sella syndrome is rare. We report a case of a female patient discovered with this association. It’s about a female patient 47 years old, followed up since the age of 31 years for bilateral galactorrhea and a spaniomenorrhea. There has been no associated drug intake. Her exploration has showed a serum prolactin level of 635 mIU/L. Thyroid test results were normal T4 = 10,2ng/L and TSH = 1.76 mIU/L. A brain scan has showed an empty sella turcica. Despite the unchanged levels of prolactinemia, the evolution under dopaminergic 5 mg /D has been marked by the occurrence of a pregnancy with persistent moderate hyperprolactinemia in the postpartum. Chromatography has showed a predominance of the macroprolactin form with: Prolactin monomer at 4.8%, Big Prolactin at 5% and Big Big Prolactin at 83%, thus stopping bromocriptine. Our observation suggests that macroprolactinemia can be associated with conventional etiologies of moderate hyperprolactinemia as the empty sella syndrome. Its detection would prevent the use of dopaminergic therapy which seems not useful.
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Affiliation(s)
- Ach Taieb
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
| | - Kacem Njah Maha
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
| | - Yosra Hasni El Abed
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
| | - Amel Maaroufi Beizig
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
| | - Molka Chaieb Chadli
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
| | - Koussay Ach
- Endocrinology and Diabetes Department, University Hospital Farhat Hached Sousse, Tunisia
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Favresse J, Bastin P, Fillée C, Luyckx F, Maiter D, Gruson D. Tracking Macroprolactin: Use of an Optimized Polyethylene Glycol Precipitation Method More Compatible with the Requirements and Processes of Automated Core Laboratories. ACTA ACUST UNITED AC 2017; 1:661-667. [DOI: 10.1373/jalm.2016.022632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
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Che Soh NA, Omar J, Wan Mohamed WM, Abdullah MR, Yaacob NM. Low prevalence of macroprolactinaemia among patients with hyperprolactinaemia screened using polyethylene glycol 8000. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Samson SL, Hamrahian AH, Ezzat S. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: CLINICAL RELEVANCE OF MACROPROLACTIN IN THE ABSENCE OR PRESENCE OF TRUE HYPERPROLACTINEMIA. Endocr Pract 2016; 21:1427-35. [PMID: 26642103 DOI: 10.4158/ep15938.dsc] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the current literature regarding the prevalence of macroprolactin (macroPRL) in hyperprolactinemic patients and determine recommendations for testing. METHODS An electronic United States National Library of Medicine PubMed search (through October, 2014) was conducted for search term "macroprolactin." Only English-language articles were considered. RESULTS MacroPRL is an under-recognized cause of elevated prolactin (PRL) and is present in approximately 4% to 40% of hyperprolactinemic patients depending on the referral population. Clinical findings which could be due to hyperprolactinemia are the impetus for testing for PRL. Because of this there is significant overlap in the clinical presentation of patients with true hyperprolactinemia and those with macroPRL, differentiation cannot always be made on the basis of symptoms. A lack of recognition of the presence of macroPRL can lead to unnecessary laboratory investigations, imaging, and pharmacologic or surgical treatment. CONCLUSION Until there is a commercially available PRL assay that is not subject to interference by macroPRL, clinicians should consider the possibility of macroPRL, especially if the clinical presentation, imaging findings, and/or response to therapy reveal inconsistencies.
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Chen Y, Wang H, Yang W, Jin W, Yu W, Wang W, Zhang K, Song G. A New Method of Using Polyethylene Glycol (PEG) Precipitation of Macroprolactin to Detect Genuine Hyperprolactinemia. J Clin Lab Anal 2016; 30:1169-1174. [PMID: 27219457 DOI: 10.1002/jcla.21999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/20/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The most commonly used method of polyethylene glycol (PEG) precipitation for macroprolactinemia (MP) screening has some significant drawbacks. The aim of this study was to establish a new method using PEG for precipitation of macroprolactin (macroPRL) to detect genuine hyperprolactinemia (genuine HP). METHODS The optimal PEG concentration for precipitation and the effect of PEG on the precipitation of PRL were analyzed to establish and optimize our PEG precipitation method. The PRL recovery rate and genuine HP detection rate were compared between our method and MP screening method. RESULTS About 25% PEG6000 was determined to be the optimal PEG concentration for precipitation. Along with an increase in protein concentration in the PRL calibration solution, the PRL recovery rate after precipitation decreased gradually. The PRL recovery rate increased when the precipitation was carried out with diluted PRL calibration solution; the recovery rate reached greater than 90% after a 5-fold dilution of the calibration solution. The genuine HP detection rate and PRL recovery rate using our diluted serum PEG precipitation method were significantly higher than those obtained with the MP screening method. Our method successfully detected 31 cases of genuine HP, which was significantly higher than the detection rate obtained using the MP screening method (25 cases; P < 0.001). CONCLUSION Precipitation using 5-fold diluted serum with 25% PEG6000 can effectively reduce the macroPRL concentration, increasing the PRL recovery rate and detection rate of genuine HP after precipitation, which is an effective and convenient method for the detection of genuine HP.
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Affiliation(s)
- Yongjian Chen
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Huan Wang
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wei Yang
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Weidong Jin
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wenge Yu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wei Wang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kailin Zhang
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Guangzhong Song
- Department of Laboratory Medicine, Hangzhou Medical College, Hangzhou, China.
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El Mahdy Korah T, Abd Elfatah Badr E, Mohamed Emara M, Ahmed Samy Kohla M, Gamal Saad Michael G. Relation between sex hormones and hepatocellular carcinoma. Andrologia 2016; 48:948-955. [PMID: 26791111 DOI: 10.1111/and.12536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2015] [Indexed: 02/06/2023] Open
Abstract
Males have higher incidence of hepatocellular carcinoma (HCC) than females. Sex hormones may be a risk factor. The aim was to determine the levels of sex hormones in male and female patients with HCC and cirrhosis versus controls and its possible relationship with HCC. This study was conducted on 90 subjects divided into 40 patients with HCC, 30 patients with liver cirrhosis and 20 apparently healthy subjects complete blood picture, liver function tests. Determination of AFP levels and hormonal assay of oestrogen, progesterone, total testosterone, prolactin, FSH and LH were performed on all subjects. Total testosterone levels were significantly decreased in the two patients groups compared with controls. While oestrogen levels were significantly decreased in the HCC group in comparison with other two groups, prolactin levels were significantly decreased in the HCC group compared with the liver cirrhosis group and increased in the liver cirrhosis group when compared to controls. FSH and LH levels were significantly increased in the HCC group when compared to controls. There is no significant correlation between sex hormones assay and both the size of HCC and degree of cirrhosis in both patient groups. It is concluded that there is no strong relation between sex hormones and HCC when the study was carried out on the levels of sex hormones in patients with HCC.
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Affiliation(s)
- T El Mahdy Korah
- Internal Medicine Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | - E Abd Elfatah Badr
- Medical Biochemistry Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt.
| | - M Mohamed Emara
- Internal Medicine Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | | | - G Gamal Saad Michael
- Internal Medicine Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
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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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Parlant-Pinet L, Harthé C, Roucher F, Morel Y, Borson-Chazot F, Raverot G, Raverot V. Macroprolactinaemia: a biological diagnostic strategy from the study of 222 patients. Eur J Endocrinol 2015; 172:687-95. [PMID: 25755230 DOI: 10.1530/eje-14-1073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/09/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Gel filtration chromatography (GFC), the gold standard for macroprolactinaemia (MPRL) diagnosis, is a slow, costly and labour-intensive method. To limit the number of GFC required, we evaluated two screening tests for MPRL: prolactin (PRL) recovery after polyethylene glycol (PEG) precipitation and PRL concentration ratio, derived from two assays, each having different big-big-PRL cross-reactivities.In some patients, MPRL is characterised by clinical symptoms which can be associated with an excess of monomeric PRL. We compared the monomeric PRL concentration obtained from GFC with the PRL concentration i) on a cobas e 601 analyser and ii) in the supernatant after PEG precipitation. DESIGN AND METHODS We studied hyperprolactinaemic sera subjected to physician-ordered GFC, between February 2013 and July 2014. We performed PEG precipitation (to evaluate the PRL concentration and rate of recovery in the supernatant) and two PRL assays: RIA and electrochemiluminescent assay (ECLIA), on a Roche cobas e 601 analyser, and calculated the RIA/ECLIA ratio. RESULTS Among the 222 sera, we were able to diagnose or exclude MPRL in 72.1% of cases, based solely on the ratio and/or recovery. In the remaining cases, GFC was necessary for making a diagnosis. Elevated monomeric PRL was present in 10.9% of macroprolactinaemic sera. In the case of MPRL, both PRL measurements on the cobas analyser and in the supernatant weakly correlated with monomeric PRL values obtained from GFC. CONCLUSIONS The combination of PEG and RIA/ECLIA ratio analysis reduced the number of necessary GFC. However, GFC is essential in MPRL cases to evaluate the monomeric PRL concentration.
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Affiliation(s)
- Lucile Parlant-Pinet
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Catherine Harthé
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Florence Roucher
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Yves Morel
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Françoise Borson-Chazot
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Gérald Raverot
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
| | - Véronique Raverot
- Faculté de Médecine Lyon-EstUniversité Claude Bernard Lyon 1, Lyon, FranceHospices Civils de LyonLaboratoire d'Hormonologie, Centre de Biologie et de Pathologie EstHospices Civils de LyonFédération d'endocrinologie, Groupement Hospitalier Est, 59 bd Pinel, F-69677 Bron Cedex, France
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Abstract
Prolactin is a hormone that is mainly secreted by lactotroph cells of the anterior pituitary gland, and is involved in many biological processes including lactation and reproduction. Animal models have provided insights into the biology of prolactin proteins and offer compelling evidence that the different prolactin isoforms each have independent biological functions. The major isoform, 23 kDa prolactin, acts via its membrane receptor, the prolactin receptor (PRL-R), which is a member of the haematopoietic cytokine superfamily and for which the mechanism of activation has been deciphered. The 16 kDa prolactin isoform is a cleavage product derived from native prolactin, which has received particular attention as a result of its newly described inhibitory effects on angiogenesis and tumorigenesis. The discovery of multiple extrapituitary sites of prolactin secretion also increases the range of known functions of this hormone. This Review summarizes current knowledge of the biology of prolactin and its receptor, as well as its physiological and pathological roles. We focus on the role of prolactin in human pathophysiology, particularly the discovery of the mechanism underlying infertility associated with hyperprolactinaemia and the identification of the first mutation in human PRLR.
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Affiliation(s)
- Valérie Bernard
- Inserm U1185, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France
| | - Jacques Young
- Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 78 rue du Général Leclerc 94275 Le Kremlin-Bicêtre Cedex, France
| | - Philippe Chanson
- Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 78 rue du Général Leclerc 94275 Le Kremlin-Bicêtre Cedex, France
| | - Nadine Binart
- Inserm U1185, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France
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Vilar L, Fleseriu M, Bronstein MD. Challenges and pitfalls in the diagnosis of hyperprolactinemia. ACTA ACUST UNITED AC 2015; 58:9-22. [PMID: 24728159 DOI: 10.1590/0004-2730000003002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022]
Abstract
The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population.
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Affiliation(s)
- Lucio Vilar
- Division of Endocrinology, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Maria Fleseriu
- Departments of Medicine and Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Kasum M, Pavičić-Baldani D, Stanić P, Orešković S, Šarić JM, Blajić J, Juras J. Importance of macroprolactinemia in hyperprolactinemia. Eur J Obstet Gynecol Reprod Biol 2014; 183:28-32. [DOI: 10.1016/j.ejogrb.2014.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/12/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Whitehead SJ, Cornes MP, Ford C, Gama R. Reference ranges for serum total and monomeric prolactin for the current generation Abbott Architect assay. Ann Clin Biochem 2014; 52:61-6. [PMID: 25074991 DOI: 10.1177/0004563214547779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exclusion of macroprolactinaemia, a well-recognised interference, as the cause of hyperprolactinaemia is essential to avoid potential misdiagnosis and mismanagement of patients. We have derived gender-specific serum total and post-polyethylene glycol (PEG) precipitation monomeric reference ranges for the recently re-standardised Abbott Architect prolactin assay. METHODS Prolactin was measured in serum samples obtained from males (n=49) and females (n=52) using the current Abbott Architect immunoassay pre- and post-PEG precipitation. Gender-specific reference ranges were derived for total and monomeric (post-PEG) prolactin. Routine patients' samples (n=175) with a serum total prolactin >700 mIU/L were screened for macroprolactinaemia to assess classification compared with our previous post-PEG precipitation percentage recovery-based approach. RESULTS Reference ranges for serum total prolactin were 58-419 mIU/L (male) and 63-561 mIU/L (female). Male and female monomeric prolactin reference ranges were 32-309 mIU/L and 39-422 mIU/L, respectively. Mean (SD) post-PEG percentage recovery of the IS 84/500 prolactin standard was 80 (2.3)%. Of 175 patients' samples screened for macroprolactinaemia, 149 had monomeric prolactin concentrations (median monomeric prolactin=1035 mIU/L; median recovery=83%) above the gender-specific reference range. Monomeric prolactin concentrations (median monomeric prolactin=162 mIU/L; median recovery=20%) in the remaining 26 were within the reference ranges. One patient classified as macroprolactin positive and another classified as macroprolactin negative would not have been identified as such using the previous recovery-based approach. CONCLUSIONS The use of post-PEG monomeric reference ranges not only identifies hyperprolactinaemia due solely to macroprolactinaemia but has the added advantage of identifying patients who have simultaneous true monomeric hyperprolactinaemia and elevated concentrations of macroprolactin.
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Affiliation(s)
- S J Whitehead
- Department of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK
| | - M P Cornes
- Department of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK
| | - C Ford
- Department of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK
| | - R Gama
- Department of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK Research Institute in Healthcare Sciences, Wolverhampton University, Wolverhampton, West Midlands, UK
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Nakano K, Moriyama T, Yasuda K, Shibuya H, Tajima T, Shigematsu A, Shimizu C. Identification of IgG-κ type macroprolactin found in the serum of an 8-year-old girl. Clin Chim Acta 2014; 433:206-8. [DOI: 10.1016/j.cca.2014.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022]
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A patient with a high concentration of B-type natriuretic peptide (BNP) but normal N-terminal proBNP concentration: A case report. Clin Biochem 2014; 47:1136-7. [PMID: 24863962 DOI: 10.1016/j.clinbiochem.2014.05.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES A 61-year-old female presented with non-typical chest pain. High levels of plasma B-type natriuretic peptide (BNP; result 3188 ng/L, reference range<100 ng/L, method Abbott Architect) were found, although she did not exhibit dyspnoea or other clinical symptoms of heart failure. Echocardiography did not provide an explanation for the elevated BNP concentrations. In follow-up, the chest pain complaints disappeared but BNP remained elevated at the same levels. The serum N-terminal proBNP (NT-proBNP) concentration appeared to be normal. This led us to doubt the accuracy of the BNP values. DESIGN AND METHODS Possible interference was investigated with BNP and NT-proBNP assays from different manufacturers, various (auto)antibody tests, sample dilutions, addition of mouse serum and polyethylene glycol (PEG) precipitation. RESULTS BNP and NT-proBNP concentrations were normal when measured using all other (NT-pro)BNP immunoassays. Serial dilutions of sample and addition of mouse serum did not alter the results. Specific (auto)antibody tests were negative. However, PEG precipitation showed the presence of a high molecular weight immunoreactive protein. CONCLUSIONS We report a false positive BNP result possibly caused by a macro-BNP. This macro-BNP was only immunoreactive in the Abbott Architect BNP immunoassay. Clinicians should be aware of analytical interference when BNP results are constantly elevated in the absence of (non)cardiac causes.
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Abstract
Prolactinomas are the most frequent pituitary adenomas. In patients with prolactinomas the primary cause of hyperprolactinemia is excessive and autonomic production of prolactin by lactotroph cells. In other conditions, except in case of macroprolactinemia, hyperprolactinemia is secondary to circumstances that stimulate secretion of prolactin by intrinsically normal lactotroph cells, or, rarely, that are the result of decreased clearance of prolactin. In general, cabergoline is the preferred treatment for micro- and macroprolactinomas, because it is more effective with respect to normalization of prolactin levels and reduction of prolactinoma size and because it has fewer side-effects compared to bromocriptine. Recently, it has been suggested that a standardized, individualized, stepwise, dose-escalating regimen of cabergoline may normalize prolactin levels and reduce prolactinoma size in patients who were otherwise considered to be dopamine agonist resistant. In general, the cardiac adverse effects of dopamine agonists reported in Parkinson's disease are not of clinical concern in the treatment of prolactinomas, which are treated with much lower doses. Nonetheless, there is uncertainty with respect to the dose and duration of cabergoline treatment, which requires echocardiographic follow-up. Although withdrawal of dopamine agonists may be considered in patients with prolactinomas well controlled by dopamine agonists, especially in postmenopausal women, recurrence of signs and symptoms may occur in a considerable portion of patients.
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Affiliation(s)
- Johannes A Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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44
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Abstract
Serum prolactin is frequently measured when investigating patients with reproductive disorders and elevated concentrations are found in up to 17% of such cases. Clinical laboratories rely predominantly on automated analysers to quantify prolactin levels using sandwich immunometric methodologies. Though generally robust and reliable, such immunoassays are susceptible to interference from a high molecular mass prolactin/IgG autoantibody complex termed macroprolactin. While macroprolactin remains reactive to varying degrees in all prolactin immunoassays, it exhibits little if any biological activity in vivo and consequently its presence is considered clinically irrelevant. Macroprolactinaemia, defined as hyperprolactinaemia due to excess macroprolactin with normal concentrations of bioactive monomeric prolactin, may lead to misdiagnosis and mismanagement of hyperprolactinemic patients if not recognised. Current best practice recommends that all sera with elevated total prolactin concentrations are sub-fractionated using polyethylene glycol precipitation to provide a more meaningful clinical measurement of the bioactive monomeric prolactin content. Manufacturers of prolactin assays should strive to minimise interference from macroprolactin in their assays. Clinical laboratories should introduce screening procedures to exclude macroprolactinaemia in all patients identified as having hyperprolactinaemia. Clinicians should be aware of this potential diagnostic pit fall and insist on PEG screening of all hyperprolactinaemic sera.
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Affiliation(s)
- Michael Fahie-Wilson
- Department of Clinical Chemistry, Southend Hospital, Westcliff-on-Sea, Essex SSO ORY, United Kingdom.
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Schmidt M, Sofronescu A, Short B, Nahas Z, Zhu Y. Increased prolactin concentrations in a patient with bipolar disorder. Clin Chem 2013; 59:473-5. [PMID: 23449699 DOI: 10.1373/clinchem.2011.176925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew Schmidt
- Department of Psychiatry, University of South Carolina, Charleston, SC 29425, USA
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Leaños-Miranda A, Ramírez-Valenzuela KL, Campos-Galicia I, Chang-Verdugo R, Chinolla-Arellano LZ. Frequency of Macroprolactinemia in Hyperprolactinemic Women Presenting with Menstrual Irregularities, Galactorrhea, and/or Infertility: Etiology and Clinical Manifestations. Int J Endocrinol 2013; 2013:478282. [PMID: 24194758 PMCID: PMC3806165 DOI: 10.1155/2013/478282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/15/2013] [Accepted: 08/30/2013] [Indexed: 11/17/2022] Open
Abstract
Aim. To determine the frequency of macroprolactinemia, its etiology, and the clinical manifestations in patients with hyperprolactinemia presenting with menstrual irregularities, galactorrhea, and/or infertility who were attended by the gynecology-endocrinology service. Methods. In a cross-sectional study, 326 hyperprolactinemic women were tested for serum prolactin (PRL) concentrations before and after chromatographic separation (gel filtration and affinity with protein G) and extraction of free PRL with polyethylene glycol (PEG). Results. Sera from 57 patients (17.5%) were found to have macroprolactinemia. The presence of macroprolactinemia was attributable to anti-PRL autoantibodies in 54 (94.7%) patients. The median serum PRL levels were similar in patients with or without macroprolactinemia (42.0 versus 38.1 ng/mL). In contrast, patients with macroprolactinemia had lower serum-free PRL levels (median 9.2 versus 31.7 ng/mL, P < 0.001). Patients without macroprolactinemia had a higher frequency of galactorrhea and abnormal pituitary imagine findings (P < 0.002). Conclusions. We can conclude that macroprolactinemia should be considered as a benign variant, and it must be ruled out in women presenting with menstrual irregularities, galactorrhea, and/or infertility in order to investigate other causes different than hyperprolactinemia. Serum PRL precipitated with PEG is a convenient and simple procedure to screen for the presence of macroprolactinemia.
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Affiliation(s)
- Alfredo Leaños-Miranda
- Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, Don Luis No. 111, Col. Nativitas, 03500 México, DF, Mexico
- *Alfredo Leaños-Miranda:
| | - Karla Leticia Ramírez-Valenzuela
- Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, Don Luis No. 111, Col. Nativitas, 03500 México, DF, Mexico
| | - Inova Campos-Galicia
- Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, Don Luis No. 111, Col. Nativitas, 03500 México, DF, Mexico
| | - Rosario Chang-Verdugo
- Clinical Laboratory, Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, México, DF, Mexico
| | - Lizbeth Zarela Chinolla-Arellano
- Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, Don Luis No. 111, Col. Nativitas, 03500 México, DF, Mexico
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Kasum M, Oreskovic S, Zec I, Jezek D, Tomic V, Gall V, Adzic G. Macroprolactinemia: new insights in hyperprolactinemia. Biochem Med (Zagreb) 2012; 22:171-9. [PMID: 22838183 PMCID: PMC4062336 DOI: 10.11613/bm.2012.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hypersecretion of prolactin by lactotroph cells of the anterior pituitary may lead to hyperprolactinemia in physiological, pathological and idiopathic conditions. Most patients with idiopathic hyperprolactinemia may have radiologically undetected microprolactinomas, but some may present other causes of hyperprolactinemia described as macroprolactinemia. This condition corresponds to the predominance of higher molecular mass prolactin forms (big-big prolactin, MW > 150 kDa), that have been postulated to represent prolactin monomer complexed with anti-prolactin immunoglobulins or autoantibodies. The prevalence of macroprolactinemia in hyperprolactinemic populations between 15–46% has been reported. In the pathophysiology of macroprolactinemia it seems that pituitary prolactin has antigenicity, leading to the production of anti-prolactin autoantibodies, and these antibodies reduce prolactin bioactivity and delay prolactin clearance. Antibody-bound prolactin is big enough to be confined to vascular spaces, and therefore macroprolactinemia develops due to the delayed clearance of prolactin rather than increased production. Although the clinical symptoms are less frequent in macroprolactinemic patients, they could not be diff erentiated from true hyperprolactinemic patients, on the basis of clinical features alone. Although gel filtration chromatography (GFC) is known to be the gold standard for detecting macroprolactin, the polyethylene glycol precipitation (PEG) method has off ered a simple, cheap, and highly suitable alternative. In conclusion, macroprolactinemia can be considered a benign condition with low incidence of clinical symptoms and therefore hormonal and imaging investigations as well as medical or surgical treatment and prolonged follow-up are not necessary.
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Affiliation(s)
- Miro Kasum
- Department of Obstetrics and Gynaecology, University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia.
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Veljkovic K, Servedio D, Don-Wauchope AC. Reporting of post-polyethylene glycol prolactin: precipitation by polyethylene glycol 6000 or polyethylene glycol 8000 will change reference intervals for monomeric prolactin. Ann Clin Biochem 2012; 49:402-4. [DOI: 10.1258/acb.2011.011238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background When screening for macroprolactin, many laboratories use precipitation by polyethylene glycol (PEG) with molecular weight 6000 (PEG6000) or 8000 (PEG8000), and report the percentage prolactin recovery. It has been proposed that reporting of percentage prolactin recovery should be replaced by absolute post-PEG prolactin; however, the post-PEG prolactin reference interval has been established using PEG6000 only. We sought to determine whether the use of PEG8000, instead of PEG6000, changed post-PEG prolactin concentrations. Methods We compared the post-PEG6000 and post-PEG8000 prolactin concentrations in hyperprolactinaemic serum samples referred for macroprolactin screening ( n = 40), using Passing–Bablok regression analysis and Bland–Altman difference plot. Results The median (25th–75th percentile, range) total prolactin, post-PEG6000 and post-PEG8000 prolactin concentrations were, respectively, 36 (31–46, 23–83) μg/L, 27 (20–38, 18–72) μg/L and 24 (18–35, 16–64) μg/L for male serum samples ( n = 5); and 56 (39–83, 24–596) μg/L, 45 (31–67, 8–503) μg/L and 41 (28–62, 6–457) μg/L for female serum samples ( n = 35) (mIU/L conversion factor: 21.2). The Passing–Bablok analysis demonstrated a significant constant bias of −1.27 and a non-significant proportional bias of 0.96. The Bland–Altman plot showed a bias of −8.2% (95% limits of agreement −19.3–2.9%). Conclusions There is a significant constant bias between the two macroprolactin precipitation methods. We changed our PEG precipitation to a PEG6000 method. Laboratories that use PEG8000 should consider the transference of the reference interval established with PEG6000 carefully.
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Affiliation(s)
- Kika Veljkovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1
| | - Dominic Servedio
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario L8N 4A6, Canada
| | - Andrew C Don-Wauchope
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario L8N 4A6, Canada
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Isik S, Berker D, Tutuncu YA, Ozuguz U, Gokay F, Erden G, Ozcan HN, Kucukler FK, Aydin Y, Guler S. Clinical and radiological findings in macroprolactinemia. Endocrine 2012; 41:327-33. [PMID: 22187359 DOI: 10.1007/s12020-011-9576-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/30/2011] [Indexed: 11/29/2022]
Abstract
Hyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8 ± 10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0 ± 10.1 vs. 30.7 ± 9.8, P = 0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 ± 347.0 vs. 238.8 ± 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels.
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Affiliation(s)
- Serhat Isik
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Training and Research Hospital, Talatpasa Bulvari, Samanpazari-Altindag, 06100 Ankara, Turkey.
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