Background: Macroprolactinemia can be an overlooked cause of hyperprolactinemia. To document the presence of macroprolactin in serum indirectly, an initial precipitation of the complexed prolactin (PRL)  using polyethylene glycol (PEG) is followed by measurement of free and total prolactin by immunoassay.
Objectives: Adaptation of the PEG method to our PRL immunoassay to detect cases with predominant macroprolactinemia and to study the short- and long-term changes of the relationship between PRL forms.
Material and Methods: One hundred forty hyperprolactinemic patients (aged 17-72 years) in whom macroprolactin constituted ≥ 60% of the total PRL were included in our study. The predominance of macroprolactin was measured by adapted PEG procedure, followed by immunoradiometric and chemiluminescence methods.
Long-term observations with repeated serum PRL measurements were made in 20 cases. For another 20 of 41 patients with indications for metoclopramide (MCP) stimulation test, we analyzed short-term alterations in free and complexed PRL levels.
Results: Adjustment of the PEG method by testing samples in dilution minimized the interference of PEG in the immunoassays and let proper detection of predominant macroprolactinemia. During the long-term observations, the ratio of macroprolactin to total PRL remained relatively constant, independent of changes in total PRL levels. During the MCP test, in the majority of patients with macroprolactinemia (except those with associated PRL-secreting adenoma), an acute rise of PRL level followed by a rise in macroprolactin resulted in a short-term decrease in macroprolactin/total PRL ratio.
Conclusions: Confirmation of the predominance in serum of macroprolactin explains the discordance between the raised PRL level and scant of absent symptoms characteristic for hyperprolactinemia. Its proper detection can influence further management.

"/> Background: Macroprolactinemia can be an overlooked cause of hyperprolactinemia. To document the presence of macroprolactin in serum indirectly, an initial precipitation of the complexed prolactin (PRL)  using polyethylene glycol (PEG) is followed by measurement of free and total prolactin by immunoassay.
Objectives: Adaptation of the PEG method to our PRL immunoassay to detect cases with predominant macroprolactinemia and to study the short- and long-term changes of the relationship between PRL forms.
Material and Methods: One hundred forty hyperprolactinemic patients (aged 17-72 years) in whom macroprolactin constituted ≥ 60% of the total PRL were included in our study. The predominance of macroprolactin was measured by adapted PEG procedure, followed by immunoradiometric and chemiluminescence methods.
Long-term observations with repeated serum PRL measurements were made in 20 cases. For another 20 of 41 patients with indications for metoclopramide (MCP) stimulation test, we analyzed short-term alterations in free and complexed PRL levels.
Results: Adjustment of the PEG method by testing samples in dilution minimized the interference of PEG in the immunoassays and let proper detection of predominant macroprolactinemia. During the long-term observations, the ratio of macroprolactin to total PRL remained relatively constant, independent of changes in total PRL levels. During the MCP test, in the majority of patients with macroprolactinemia (except those with associated PRL-secreting adenoma), an acute rise of PRL level followed by a rise in macroprolactin resulted in a short-term decrease in macroprolactin/total PRL ratio.
Conclusions: Confirmation of the predominance in serum of macroprolactin explains the discordance between the raised PRL level and scant of absent symptoms characteristic for hyperprolactinemia. Its proper detection can influence further management.

"/>
ARTICLE AUTHORS
ARTICLE INFO

140 Cases of Macroprolactinemia: Selected Clinical and Technical Laboratory Aspects

AUTHORS

Wojciech Jeske 1 , * , Piotr Glinicki 2 , Renata Kapuscinska 2 , Wojciech Zgliczynski 2

1 Department of Endocrinology, The Medical Centre of Postgraduate ducation, [email protected], Poland

2 Department of Endocrinology, The Medical Centre of Postgraduate ducation, Poland

How to Cite: Jeske W, Glinicki P, Kapuscinska R, Zgliczynski W. 140 Cases of Macroprolactinemia: Selected Clinical and Technical Laboratory Aspects, Int J Endocrinol Metab. Online ahead of Print ; 10(1):394-398. doi: 10.5812/ijem.3600.

ARTICLE INFORMATION

International Journal of Endocrinology and Metabolism: 10 (1); 394-398
Article Type: Original Article
Received: November 22, 2011
Accepted: December 20, 2011
DOI : 10.5812/ijem.3600
Crossmark
Crossmark
CHECKING
READ FULL TEXT

Abstract

Background: Macroprolactinemia can be an overlooked cause of hyperprolactinemia. To document the presence of macroprolactin in serum indirectly, an initial precipitation of the complexed prolactin (PRL)  using polyethylene glycol (PEG) is followed by measurement of free and total prolactin by immunoassay.
Objectives: Adaptation of the PEG method to our PRL immunoassay to detect cases with predominant macroprolactinemia and to study the short- and long-term changes of the relationship between PRL forms.
Material and Methods: One hundred forty hyperprolactinemic patients (aged 17-72 years) in whom macroprolactin constituted ≥ 60% of the total PRL were included in our study. The predominance of macroprolactin was measured by adapted PEG procedure, followed by immunoradiometric and chemiluminescence methods.
Long-term observations with repeated serum PRL measurements were made in 20 cases. For another 20 of 41 patients with indications for metoclopramide (MCP) stimulation test, we analyzed short-term alterations in free and complexed PRL levels.
Results: Adjustment of the PEG method by testing samples in dilution minimized the interference of PEG in the immunoassays and let proper detection of predominant macroprolactinemia. During the long-term observations, the ratio of macroprolactin to total PRL remained relatively constant, independent of changes in total PRL levels. During the MCP test, in the majority of patients with macroprolactinemia (except those with associated PRL-secreting adenoma), an acute rise of PRL level followed by a rise in macroprolactin resulted in a short-term decrease in macroprolactin/total PRL ratio.
Conclusions: Confirmation of the predominance in serum of macroprolactin explains the discordance between the raised PRL level and scant of absent symptoms characteristic for hyperprolactinemia. Its proper detection can influence further management.

  • Implication for health policy/practice/research/medical education:
    Macroprolactinemia can be an overlooked cause of hyperprolactinemia and this may lead to misdiagnosis and mismanagement.Therefore proper detection of macroprolactin is important for clinical practice.
  • Please cite this paper as:
    Jeske W, Glinicki P, Kapuscinska R, Zgliczynski W. 140 cases of Macroprolactinemia: Selected Clinical and Technical Laboratory Aspects,Poland. Int J Endocrinol Metabol. 2012;10(1) : 394-8. DOI: 10.5812/ijem.3600
                                                                                       Copyright © 2012 Kowsar M. P. Co. All rights reserved.

Full Text

Full text is available in PDF

© 0, International Journal of Endocrinology and Metabolism. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
COMMENTS

LEAVE A COMMENT HERE: