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Nishiyama N, Hattori N, Aisaka K, Ishihara M, Saito T. Macroprolactin in mothers and their babies: what is its origin? Clin Chem Lab Med 2024; 0:cclm-2024-0235. [PMID: 38680064 DOI: 10.1515/cclm-2024-0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Macroprolactinemia is one of the major causes of hyperprolactinemia. The aim of this study was to clarify the origin of macroprolactin (macro-PRL). METHODS We examined macro-PRL in the sera of 826 pregnant women and in those of their babies' umbilical cords at delivery. Macro-PRL was evaluated by precipitation with polyethylene glycol (PEG), gel filtration chromatography (GFC), and absorption with protein G (PG). RESULTS We detected macro-PRL in 16 out of the 826 pregnant women (1.94 %) and in 14 of their babies, which may indicate the possibility of hereditary origin of macro-PRL. However, the macro-PRL ratios of the babies correlated positively with those of their mothers (r=0.72 for GFC, p<0.001 and r=0.77 for PG, p<0.001), suggesting that the immunoglobulin (Ig)G-type anti-PRL autoantibodies might be actively transferred to babies via the placenta and form macro-PRL by binding to their babies' PRL or PRL-IgG complexes may possibly pass through the placenta. There were two cases in which only mothers had macro-PRL, indicating that the mothers had autoantibodies that did not pass through the placenta, such as IgA, PRL bound to the other proteins or PRL aggregates. No cases were found in which only the babies had macro-PRL and their mothers did not, suggesting that macro-PRL might not arise by non-hereditary congenital causes. CONCLUSIONS Macro-PRL in women of reproductive age might be mostly IgG-type anti-PRL autoantibody-bound PRL. The likely origin of macro-PRL in babies is the transplacental transfer of IgG-type anti-PRL autoantibodies or PRL-IgG complexes from the mothers to their babies.
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Affiliation(s)
- Norito Nishiyama
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | - Naoki Hattori
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | - Kohozo Aisaka
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | - Takanori Saito
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
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2
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Koniares K, Benadiva C, Engmann L, Nulsen J, Grow D. Macroprolactinemia: a mini-review and update on clinical practice. F S Rep 2023; 4:245-250. [PMID: 37719092 PMCID: PMC10504566 DOI: 10.1016/j.xfre.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 09/19/2023] Open
Abstract
Hyperprolactinemia is common among infertile patients, with up to 15%-20% of women with oligomenorrhea having hyperprolactinemia. Suppression of the hypothalamic-pituitary-gonadal axis via inhibition of pulsatile gonadotropin releasing hormone because of hyperprolactinemia is a common endocrine etiology of infertility. There are 3 forms of human prolactin (PRL): monomeric PRL, dimeric PRL, and macro-PRL. Also known as big-big PRL, macro-PRL has a molecular weight >150 kDa and normally comprises 5%-10% of circulating PRL. When the predominant form of circulating PRL is macro-PRL, macroprolactinemia is diagnosed. Among patients with hyperprolactinemia, 10%-46% have macroprolactinemia. Patients with macroprolactinemia are at risk of unnecessary pituitary imaging and treatment with dopamine agonists if not correctly diagnosed. Given the high prevalence of macroprolactinemia among patients with elevated PRL levels and the different management of patients with macroprolactinemia vs true monomeric hyperprolactinemia, all patients with persistently elevated PRL levels should be screened for macro-PRL.
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Affiliation(s)
- Katherine Koniares
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Claudio Benadiva
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Lawrence Engmann
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - John Nulsen
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Daniel Grow
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
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3
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Stelmachowska-Banaś M, Ostrowska M, Goszczyński T, Kowalski K, Korbonits M, Kapuścińska R, Zgliczyński W, Glinicki P. Macro-GH - a clinical entity causing a diagnostic challenge - a case report. Clin Chim Acta 2023; 546:117392. [PMID: 37187223 DOI: 10.1016/j.cca.2023.117392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
Abstract
AIM Presentation of a new case of a patient with macro-GH, that may interfere with different GH assays leading to false-positive results in serum samples. CASE PRESENTATION A 61-year-old female was referred with a pituitary macroadenoma and elevated growth hormone levels The laboratory tests showed increased fasting GH level, measured by a sandwich chemiluminescence immunoassay (LIAISON® XL) without suppression on oral glucose tolerance test and normal IGF-1. The patient did not have the typical signs and symptoms of acromegaly. The patient underwent a transsphenoidal resection of a pituitary tumor, showing only α-subunit immunostaining. Postoperative GH levels remained elevated. An interference in the determination of GH level was suspected. GH was analyzed by three different immunoassays, UniCel DxI 600, Cobas e411 and hGH-IRMA. Heterophilic antibodies and rheumatoid factor were not detected in serum sample. GH recovery after precipitation with 25% polyethylene glycol (PEG) was 12%. Size-exclusion chromatography confirmed the presence of macro-GH in serum sample. CONCLUSION If results of laboratory tests are not consistent with the clinical findings, the presence of an interference within immunochemical assays could be suspected. To identify interference caused by the macro-GH, the PEG method and size-exclusion chromatography should be used.
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Affiliation(s)
| | - Magdalena Ostrowska
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Tomasz Goszczyński
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Wrocław, Poland.
| | | | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.
| | - Renata Kapuścińska
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Piotr Glinicki
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland.
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4
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Ke X, Wang L, Duan L, Yang H, Yin J, Qiu L, Pan H, Gong F, Zhu H. Comparison of PEG precipitation and ultrafiltration treatment for serum macroprolactin in Chinese patients with hyperprolactinemia. Clin Chim Acta 2023; 544:117358. [PMID: 37086942 DOI: 10.1016/j.cca.2023.117358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Macroprolactinemia is a common cause of hyperprolactinemia (HPRL), with an average worldwide incidence of 18.9 %. This study aimed to explore the feasibility of ultrafiltration (UF) and polyethylene glycol (PEG) precipitation for macroprolactin screening, as well as the incidence and clinical characteristics of Chinese patients with macroprolactinemia. METHODS In this study, 94 patients with HPRL and 206 healthy individuals were included. Gel filtration chromatography (GFC), PEG precipitation, and UF were used to screen for macroprolactin, and chemiluminescence was used to determine the prolactin levels. RESULTS The detected incidence of macroprolactinemia in the patients with HPRL was 7.45% (7/94, GFC) and 5.32% (5/94, PEG precipitation). Patients with macroprolactinemia usually present with atypical clinical symptoms, moderately increased prolactin levels, and negative or microadenoma-positive pituitary images. In addition, the recovery of monomeric prolactin by PEG precipitation and UF was significantly correlated to that of GFC (r PEG=0.493, P<0.001; r UF=0.226, P=0.014), with a higher correlation coefficient between PEG precipitation and GFC. Furthermore, PEG precipitation had a smaller variation (95% confidence interval [CI]: -35.77% to 18.34%) than UF in monomeric prolactin recovery and substantial diagnostic consistency with GFC (Cohen's kappa coefficient=0.647). The proportion of monomeric prolactin in patients with HPRL did not change significantly between the two visits within one year (P >0.05). CONCLUSION The incidence of macroprolactinemia in Chinese patients with HPRL is low in the present study. Based on our analysis, we recommend that only patients who are clinically suspected of having macroprolactinemia should be screened using PEG precipitation.
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Affiliation(s)
- Xiaoan Ke
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Linjie Wang
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lian Duan
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hongbo Yang
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Hui Pan
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Fengying Gong
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Huijuan Zhu
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
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5
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Faron-Górecka A, Latocha K, Pabian P, Kolasa M, Sobczyk-Krupiarz I, Dziedzicka-Wasylewska M. The Involvement of Prolactin in Stress-Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3257. [PMID: 36833950 PMCID: PMC9959798 DOI: 10.3390/ijerph20043257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
The most important and widely studied role of prolactin (PRL) is its modulation of stress responses during pregnancy and lactation. PRL acts as a neuropeptide to support physiological reproductive responses. The effects of PRL on the nervous system contribute to a wide range of changes in the female brain during pregnancy and the inhibition of the hypothalamic-pituitary axis. All these changes contribute to the behavioral and physiological adaptations of a young mother to enable reproductive success. PRL-driven brain adaptations are also crucial for regulating maternal emotionality and well-being. Hyperprolactinemia (elevated PRL levels) is a natural and beneficial phenomenon during pregnancy and lactation. However, in other situations, it is often associated with serious endocrine disorders, such as ovulation suppression, which results in a lack of offspring. This introductory example shows how complex this hormone is. In this review, we focus on the different roles of PRL in the body and emphasize the results obtained from animal models of neuropsychiatric disorders.
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Affiliation(s)
- Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Katarzyna Latocha
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Paulina Pabian
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Iwona Sobczyk-Krupiarz
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Marta Dziedzicka-Wasylewska
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
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6
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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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7
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Zhenhua W, Haizhi C, Jing L, Xiaocong F, Jianhua L, Jianjun L, Lilei L, Haiying J. Occurrence of macroprolactinemia in schizophrenia patients treated with risperidone or amisulpride. Asia Pac Psychiatry 2022; 14:e12469. [PMID: 33754473 DOI: 10.1111/appy.12469] [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] [Received: 06/13/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate macroprolactinemia caused by antipsychotics and its clinical significance. METHODS A total of 133 patients with schizophrenia were selected, all of whom were treated with either risperidone or amisulpride alone. The levels of total prolactin (T-PRL) and macroprolactin (MPRL) were measured before treatment as well as the second, fourth, and sixth weeks of treatment. RESULTS After 2 weeks of treatment, 75.09% (100/133) of the patients met the diagnostic criteria for hyperprolactinemia, the incidence of macroprolactinemia was 43% (43/100), and MPRL levels were positively correlated T-PRL levels. CONCLUSION Risperidone and amisulpride caused hyperprolactinemia and macroprolactinemia; thus, detection of MPRL in the clinical setting should be performed as this phenomenon appears early in treatment (the second week) and continues, that can avoid unnecessary examination and treatment for asymptomatic patients with macroprolactinemia.
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Affiliation(s)
- Wang Zhenhua
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Chen Haizhi
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Li Jing
- The Center for Disease Control and Prevention of Huzhou City, Zhejiang, China
| | - Fei Xiaocong
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Li Jianhua
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Liu Jianjun
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Lei Lilei
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Jin Haiying
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
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8
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Sharma LK, Dutta D, Sharma N, Kulshreshtha B, Lal S, Sethi R. Prevalence of Macroprolactinemia in People Detected to Have Hyperprolactinemia. J Lab Physicians 2022; 13:353-357. [PMID: 34975255 PMCID: PMC8714312 DOI: 10.1055/s-0041-1732490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Macroprolactinemia is an analytic laboma encountered as a part of prolactin assay. No data are available on the burden of macroprolactinemia in Indians. This study aimed to determine the prevalence and predictors of macroprolactinemia among people with hyperprolactinemia.
Methods
Consecutive patients detected to have serum prolactin > 18 ng/mL as per the upper reference limit were further screened for macroprolactin by post-polyethylene-glycol (PEG)-precipitation test. Macroprolactinemia was defined as post-PEG recovery of prolactin < 40%.
Results
The four most common underlying etiologies for the testing of hyperprolactinemia were polycystic ovary syndrome (
n
= 402; 32.71%), pituitary adenomas (
n
= 318; 25.87%), drug-induced hyperprolactinemia (
n
= 224; 18.23%), and infertility (
n
= 126; 10.25%). A total of 1,229 patients (male:female = 191:1038) having mean age 30.46 ± 10.14 years had hyperprolactinemia, of which 168 (13.7%) were diagnosed to have macroprolactinemia. Macroprolactinemia was significantly higher in females than males (15.03 vs. 6.28%;
p
< 0.001). Age quartile-based analysis revealed no difference in occurrence of macroprolactinemia. Only 34 patients (2.76%) with macroprolactinemia (< 40% recovery of prolactin post-PEG precipitation) had raised prolactin levels after recovery. These patients primarily had underlying pituitary pathology.
Conclusion
Macroprolactinemia is not uncommon in people being tested for hyperprolactinemia. We should not hesitate to screen for macroprolactinemia in patients who have incidentally been detected to have hyperprolactinemia.
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Affiliation(s)
- Lokesh Kumar Sharma
- Department of Biochemistry, Atal Behari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi (formerly Postgraduate Institute of Medical Education & Research [PGIMER] and Dr RML Hospital, New Delhi), India
| | - Deep Dutta
- Department of Endocrinology, CEDAR Superspeciality Healthcare, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Atal Behari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi (formerly Postgraduate Institute of Medical Education & Research [PGIMER] and Dr RML Hospital, New Delhi), India
| | - Bindu Kulshreshtha
- Department of Endocrinology, ABVIMS & Dr RML Hospital, New Delhi (formerly PGIMER & Dr RML Hospital, New Delhi), India
| | - Sandhya Lal
- Department of Biochemistry, Atal Behari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi (formerly Postgraduate Institute of Medical Education & Research [PGIMER] and Dr RML Hospital, New Delhi), India
| | - Ritika Sethi
- Department of Biochemistry, Atal Behari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia (RML) Hospital, New Delhi (formerly Postgraduate Institute of Medical Education & Research [PGIMER] and Dr RML Hospital, New Delhi), India
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Ghazal K, Brabant S, Prie D, Piketty ML. Hormone Immunoassay Interference: A 2021 Update. Ann Lab Med 2022; 42:3-23. [PMID: 34374345 PMCID: PMC8368230 DOI: 10.3343/alm.2022.42.1.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/08/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
Immunoassays are powerful qualitative and quantitative analytical techniques. Since the first description of an immunoassay method in 1959, advances have been made in assay designs and analytical characteristics, opening the door for their widespread implementation in clinical laboratories. Clinical endocrinology is closely linked to laboratory medicine because hormone quantification is important for the diagnosis, treatment, and prognosis of endocrine disorders. Several interferences in immunoassays have been identified through the years; although some are no longer encountered in daily practice, cross-reaction, heterophile antibodies, biotin, and anti-analyte antibodies still cause problems. Newer interferences are also emerging with the development of new therapies. The interfering substance may be exogenous (e.g., a drug or substance absorbed by the patient) or endogenous (e.g., antibodies produced by the patient), and the bias caused by interference can be positive or negative. The consequences of interference can be deleterious when clinicians consider erroneous results to establish a diagnosis, leading to unnecessary explorations or inappropriate treatments. Clinical laboratories and manufacturers continue to investigate methods for the detection, elimination, and prevention of interferences. However, no system is completely devoid of such incidents. In this review, we focus on the analytical interferences encountered in daily practice and possible solutions for their detection or elimination.
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Affiliation(s)
- Khaldoun Ghazal
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Severine Brabant
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Dominique Prie
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Marie-Liesse Piketty
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
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Chincholkar P, Yeo CP, Ho CKM. Gender-specific reference intervals for serum prolactin concentrations before and after precipitation by polyethylene glycol. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211049838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prolactin, a hormone secreted by the anterior pituitary, exists in three major forms in circulation. The macroprolactin form is biologically inactive but contributes to elevated serum prolactin concentrations. Precipitation of macroprolactin by polyethylene glycol (PEG) is widely used in clinical laboratories for the screening of macroprolactin. The aim of this study was two-fold. Firstly, we sought to establish locally relevant reference intervals for serum prolactin and post-PEG precipitation prolactin concentrations in both genders on the Roche Cobas Prolactin II electrochemiluminescence immunoassay. Secondly, the prolactin concentrations after precipitation by PEG dissolved in phosphate-buffered saline (post-PEG(PBS)) were compared with those after precipitation by PEG dissolved in deionised water (PEG(diH2O)). Prolactin concentrations were measured by using the Prolactin Gen II assay on a Roche Cobas e601 analyser. Recoveries of prolactin after precipitation by PEG in PBS and PEG in diH2O were 64.7%–115.8% and 60.9–100.8%, respectively. Post-PEG (PBS) prolactin concentrations were not statistically different from post-PEG (diH2O) prolactin concentrations in either gender.
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Affiliation(s)
| | - Chin Pin Yeo
- Department of Clinical Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Clement Kam Man Ho
- Duke-NUS Medical School, Singapore
- Department of Pathology and Laboratory Medicine, KK Women and Children Hospital, Singapore
- Department of Pathology, Sengkang General Hospital, Singapore
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11
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Jimenez-Anon L, Barallat J, Regidor D, Urgell E, Dolade M, Granada ML. Assessment of intraindividual agreement in prolactin results after post-polyethylene glycol precipitation test for the estimation of macroprolactin. Should the precipitation procedure be repeated in the same patient? Clin Chem Lab Med 2021; 59:e27-e29. [DOI: 10.1515/cclm-2020-0858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Jimenez-Anon
- Department of Clinical Biochemistry , Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona , Crta. Canyet s/n. , Badalona , Barcelona , Spain
| | - Jaume Barallat
- Department of Clinical Biochemistry , Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona , Crta. Canyet s/n. , Badalona , Barcelona , Spain
| | - Diana Regidor
- Department of Clinical Biochemistry , Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona , Crta. Canyet s/n. , Badalona , Barcelona , Spain
| | - Eulalia Urgell
- Department of Clinical Biochemistry , Hospital de la Santa Creu i Sant Pau , C/Sant Quintí , Badalona , Barcelona , Spain
| | - Maria Dolade
- Department of Clinical Biochemistry , Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona , Crta. Canyet s/n. , Badalona , Barcelona , Spain
| | - Maria-Luisa Granada
- Department of Clinical Biochemistry , Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona , Crta. Canyet s/n. , Badalona , Barcelona , Spain
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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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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: 10] [Impact Index Per Article: 2.5] [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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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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Hattori N, Aisaka K, Chihara K, Shimatsu A. Current Thyrotropin Immunoassays Recognize Macro-Thyrotropin Leading to Hyperthyrotropinemia in Females of Reproductive Age. Thyroid 2018; 28:1252-1260. [PMID: 29943675 DOI: 10.1089/thy.2017.0624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Macro-thyrotropin (macro-TSH) is a high molecular weight form of TSH that leads to hyperthyrotropinemia. This study was undertaken to examine the prevalence and nature of macro-TSH in females of reproductive age. METHODS Blood samples were taken from 1794 female patients who visited the Hamada Obstetrics and Gynecology Hospital in Tokyo, Japan, complaining of infertility. The serum of 305 patients with TSH concentrations >2.5 mIU/L was screened for macro-TSH by the polyethylene glycol method. Samples with TSH precipitation ratios by polyethylene glycol >70% were further analyzed using gel filtration chromatography (GFC), protein G columns, and 125I-TSH binding experiments. RESULTS Screening of the 305 patients revealed that 63 had serum TSH precipitation ratios >70%. GFC revealed that immunoreactive TSH, with a molecular weight of approximately 150 kDa, eluted at higher ratios (79.6 ± 24.4%) in 27 of the 63 patients compared to 0.4 ± 2.0% in the control group. Serum TSH concentrations in 24 of the 27 patients were spuriously elevated due to human anti-mouse antibodies. Macro-TSH was found in the other three patients, and one of them had detectable anti-TSH autoantibodies. Eight of the remaining 36 patients who did not have high-molecular-weight TSH assessed by GFC had immunoglobulin G-associated TSH. Three commercially available TSH immunoassays (Elecsys®, Centaur®, and Architect®) all recognized macro-TSH leading to the elevated serum TSH concentrations. CONCLUSIONS Macro-TSH was present in 0.17% of infertile women. Commercial TSH immunoassays recognized macro-TSH, resulting in the diagnosis of hyperthyrotropinemia.
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Affiliation(s)
- Naoki Hattori
- 1 Department of Pharmaceutical Sciences, Ritsumeikan University , Shiga, Japan
| | - Kohzo Aisaka
- 2 Department of Obstetrics and Gynecology, Hamada Hospital , Tokyo, Japan
| | - Kazuhisa Chihara
- 1 Department of Pharmaceutical Sciences, Ritsumeikan University , Shiga, Japan
| | - Akira Shimatsu
- 3 Clinical Research Institute , National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Aisaka K, Tsuchiya F, Sueta M, Itabashi K, Nose S, Hasegawa A, Obata S, Hiraike H, Yokoyama T. Impact of macroprolactin on galactorrhea and the rate of patients possibly affected by macroprolactin. Endocr J 2018; 65:203-211. [PMID: 29162783 DOI: 10.1507/endocrj.ej17-0358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The clinical influence of macroprolactin (MPRL) is not clearly understood and the rate of patients potentially affected by MPRL is unknown. We investigated the influence of MPRL on the onset of galactorrhea and estimated the rate of patients with a proportion of MPRL fraction that may possibly affect galactorrhea. Data of patients with obstetric or gynecological symptoms who had undergone PRL fractionation testing were retrospectively analyzed. To evaluate factors influencing galactorrhea, a multivariate logistic regression analysis was performed and the adjusted odds ratios of MPRL for galactorrhea were calculated. Cutoff values for the total PRL level and the proportion of MPRL fractions for galactorrhea were determined by ROC analysis using a multivariate logistic model. The prevalence of patients with a proportion of MPRL fraction greater than or equal to the cutoff value for galactorrhea was estimated. The median proportion of MPRL fraction was 30.1% and increased as PRL level increased. Total PRL and MPRL had a significant influence on the onset of galactorrhea and the adjusted odds ratio was 1.09 in total PRL and 0.94 in MPRL. The rate of patients with a proportion of MPRL fraction that may possibly affect galactorrhea was estimated to be 33.5% of the study population, and thus found to be twelve times or more the number of macroprolactinemia patients. Future prospects for hyperprolactinemia may require diagnostic criteria using free prolactin levels and so MPRL fraction measurement is important for the diagnosis and treatment of patients with obstetric and gynecological symptoms.
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Affiliation(s)
- Kohzo Aisaka
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Fujiko Tsuchiya
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Masami Sueta
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Kana Itabashi
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Sayaka Nose
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Akiko Hasegawa
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Seiichiro Obata
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Haruko Hiraike
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
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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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