ABSTRACT
Objective:To describe the prevalence and clinical characteristics of macroprolactinemia in hyperprolactinemia patients.Methods:Consecutive 111 outpatients diagnosed with hyperprolactinemia were included in this study. Macroprolactin was routinely screened using the polyethylene glycol(PEG) precipitation method. Recovery of monomeric prolactin less than 40% was defined as macroprolactinemia. Clinical characteristics were analyzed in this study.Results:Among the 111 cases included, 99 were female and 12 were male, with an average age of(32.2±7.9) years. There were 32 cases(28.8%) of macroprolactinemia and 28 of them with normal monomeric prolactin levels(simple macroprolactinemia). prolactin levels before precipitation in simple macroprolactinemia were significantly lower than those with true hyperprolactinemia[(49.81±23.58 vs 83.56±65.82) ng/mL, P<0.05]. No amenorrhea and infertility were observed in patients with simple macroprolactinemia. The clinical manifestations of prolonged menstruation, oligomenorrhea and galactorrhea in female patients accounted for 25.9%, 37.0%, and 7.4%, respectively. Imaging data were obtained in 92 cases. The prevalence of pituitary adenomas in simple macroprolactinemia and true hyperprolactinemia was 42.9% and 66.0%, respectively. Fifteen(46.8%) of the macroprolactinemia cases were receiving or had received bromocriptine treatment, and 66.7% of them failed to achieve normal prolactin levels during therapy. Conclusion:Macroprolactinemia might be common in clinical practice. Macroprolactin should be screened in hyperprolactinemia patients lack of amenorrhea and infertility, and with poor response to dopamine agonist therapy.
ABSTRACT
La macroprolactinemia se define como la presencia de cantidades elevadas de esta isoforma de la prolactina en suero, en conjunto con concentraciones normales de prolactina monomérica. Se trata de una entidad bastante común, considerada entre las tres primeras causas de hiperprolactinemia. Su origen parece responder a mecanismos autoinmunes y el seguimiento de los pacientes afectos durante periodos de 10 años ha demostrado que es una condición crónica. La prueba de elección para el diagnóstico es la cromatografía líquida en columna de gel, pero este es un método costoso que generalmente es suplido por la prueba de precipitación con polietinglicol. Por mucho tiempo ha prevalecido el concepto de que estos pacientes son esencialmente asintomáticos, pero reportes recientes señalan la presencia de síntomas de hiperprolactinemia como parte significativa del cuadro, aunque la literatura actual muestra criterios divergentes. En estos pacientes la realización de resonancia magnética nuclear hipofisaria parece ser un procedimiento innecesario, basado en la escasa frecuencia de resultados positivos. El tratamiento farmacológico con agonistas dopaminérgicos muestran respuestas contradictorias en cuanto a la desaparición de los síntomas y la normalización de los niveles de prolactina. Por tanto, la inexistencia de un consenso en la literatura científica en lo referente a las manifestaciones clínicas y el manejo, obliga a una conveniente valoración individual de cada caso(AU)
Macroprolactinemia is defined as the presence of high quantities of this prolactin isoform in serum, together with normal concentrations of monomeric prolactin. It is a common entity, considered among the three first causes of hyperprolactinaemia. The origin seems to respond to autoimmune mechanisms and the affected patients follow-up during ten years periods has shown that it is a chronic condition. The standard gold test to the diagnostic is gel-filtration chromatography, but it is an expensive method that is generally supplied by the polyethylene glycol precipitation test. During a long time, the concept that these patients are essentially asymptomatic has prevailed, but recent reports stamps the presence of hyperprolactinemia symptoms as a significant part of the entity, although current literature shows divergent criteria. In these patients, performing pituitary magnetic resonance seems to be an unnecessary procedure, based on the rare frequency of positive results. Pharmacological treatment with dopamine agonists shows contradictory responses with regard to symptoms disappearance and prolactin levels normalization. Therefore, the lack of consensus in the scientific literature with regard to the clinical manifestations and the management, requires a convenient individual assessment of each case(AU)
Subject(s)
Humans , Male , Female , Prolactin/analysis , Chromatography, Liquid/methodsABSTRACT
Objective To study the possible mechanism of in vivo production and congregation of macroprolactinemia (M-PRL) . Methods 50 cases of hyperprolactinemia(HPRL) ,50 cases of M-PRL and 25 healthy persons were selected as the HPRL group , M-PRL group and control group respectively .The chemiluminescence method was adopted to detect the levels of serum hormones and thyroid hormones .Then the detection results were statistically analyzed .Results The levels of serum testosterone ,sex hormone binding globulin(SHBG) ,thyroglobulin antibody and thyroid peroxidase in the M-PRL and HPRL groups were significantly higher than those in the control group .Serum estradiol levels in the M-PRL and HPRL group were lower than those in control group ,the difference was statistically significant (P＜0 .05) .Serum Prog level of the M-PRL group was lower than that of the control group ,the difference was statistically significant (P＜0 .05) .However the levels of serum testosterone ,estradiol ,luteinizing hormone(LH) ,follicle-stimulating hormone(FSH) and SHBG ,and LH/FSH ratio had no statistical difference between the M-PRL group and HPRL group(P＞0 .05) .Conclusion Certain degrees of sex hormones abnormality and autoimmune abnormality may exist in the patients with M-PRL .
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. Arq Bras Endocrinol Metab. 2014;58(1):9-22.
A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve-se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outras doenças, muitos podem apresentar galactorreia ou distúrbios menstruais, bem como anormalidades neurorradiológicas. Finalmente, os médicos devem estar cientes de que incidentalomas hipofisários são encontrados em pelo menos 10% da população adulta. Arq Bras Endocrinol Metab. 2014;58(1):9-22.
Subject(s)
Female , Humans , Male , Hyperprolactinemia/diagnosis , Hyperprolactinemia/etiology , Prolactin/blood , Prolactinoma/complications , Chemical Precipitation , Chromatography, Gel , Galactorrhea/etiology , Magnetic Resonance Imaging , Medical History Taking , Physical Examination , Prolactin/classificationABSTRACT
Objective The experimental condition of PEG precipitation pre-treatment method associated with electrochemiluminescence was optimized to gain a coincident result compared with gel chromatography method.Methods A fixed centrifuge time,optimized centrifuge speed,temperature and iron intensity were used to achieve a best experimental condition.Results The detection concentration of micromolecular PRL was approximate to gel chromatography method under the experimental condition of being centrifuged 10 minutes at 18℃ and pretreated with 25%PEG 6000 1M PBS.Conclusions The optimized PEG precipitation test united with the electrochemillumescence immunoassy was a good method for screening macroprolactinemia in clinical diagnosis.
ABSTRACT
BACKGROUND: Prolactin has been identified by gel chromatography to exist is three different forms in human serum; monomeric prolactin(molecular mass 23kDa), big prolactin (molecular mass 50~60 kDa) and big big prolactin, otherwise known as macroprolactin(molecular mass 150~170kDa). The predominance of macroprolactinemia has long been known in idiopathic hyperprolactinemic patients with maintained fertility. In recent reports, 24% of microprolactinoma patients showed no menstrual disturbances, which was suggestive of macroprolactinemia. The purpose of this study was to evaluate: (1) the frequency of macroprolactinemia among idiopathic hyperprolactinemia and prolactinoma patients, (2) the difference in the clinical characteristics between hyperprolactinemia, with and without macroprolactinemia, among idiopathic hyperprolactinemia and prolactinoma patients, and (3) the follow-up prolactin level using the bromocriptine response. METHODS: We retrospectively analyzed the clinical characteristics and prolactin levels in 43 idiopathic hyperprolactinemia and 51 prolactinoma patients with a poor bromocriptine response. Macroprolactinemia was identified by the prolactin recovery of < 40% using the polyethylene glycol(PEG) precipitation test. RESULTS: (1) Of the 43 idiopathic hyperprolactinemia and 51 prolactinoma patients, 17(39.5%) and 9(17.6%), respectively, were macroprolactinemic(P<0.05). (2) Among the idiopathic hyperprolactinemia patients, galactorrhea combined with amenorrhea was significantly less frequent (P<0.05), with the 1- and 2-year follow-up prolactin levels being significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). (3) Among the prolactinoma patients, amenorrhea was significantly less frequent(P<0.05), but asymptomatic cases were more frequent in those with macroprolactinemia than monomeric prolactinemia(P <0.05). The 1- and 2-year follow-up prolactin levels were significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). CONCLUSION: The screening of macroprolactinemia should be considered in idiopathic hyperprolactinemia and prolactinoma patients with a poor bromocriptine response
Subject(s)
Female , Humans , Pregnancy , Amenorrhea , Bromocriptine , Chromatography, Gel , Fertility , Follow-Up Studies , Galactorrhea , Hyperprolactinemia , Mass Screening , Polyethylene , Prolactin , Prolactinoma , Retrospective StudiesABSTRACT
BACKGROUND: Prolactin has been identified by gel chromatography to exist is three different forms in human serum; monomeric prolactin(molecular mass 23kDa), big prolactin (molecular mass 50~60 kDa) and big big prolactin, otherwise known as macroprolactin(molecular mass 150~170kDa). The predominance of macroprolactinemia has long been known in idiopathic hyperprolactinemic patients with maintained fertility. In recent reports, 24% of microprolactinoma patients showed no menstrual disturbances, which was suggestive of macroprolactinemia. The purpose of this study was to evaluate: (1) the frequency of macroprolactinemia among idiopathic hyperprolactinemia and prolactinoma patients, (2) the difference in the clinical characteristics between hyperprolactinemia, with and without macroprolactinemia, among idiopathic hyperprolactinemia and prolactinoma patients, and (3) the follow-up prolactin level using the bromocriptine response. METHODS: We retrospectively analyzed the clinical characteristics and prolactin levels in 43 idiopathic hyperprolactinemia and 51 prolactinoma patients with a poor bromocriptine response. Macroprolactinemia was identified by the prolactin recovery of < 40% using the polyethylene glycol(PEG) precipitation test. RESULTS: (1) Of the 43 idiopathic hyperprolactinemia and 51 prolactinoma patients, 17(39.5%) and 9(17.6%), respectively, were macroprolactinemic(P<0.05). (2) Among the idiopathic hyperprolactinemia patients, galactorrhea combined with amenorrhea was significantly less frequent (P<0.05), with the 1- and 2-year follow-up prolactin levels being significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). (3) Among the prolactinoma patients, amenorrhea was significantly less frequent(P<0.05), but asymptomatic cases were more frequent in those with macroprolactinemia than monomeric prolactinemia(P <0.05). The 1- and 2-year follow-up prolactin levels were significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). CONCLUSION: The screening of macroprolactinemia should be considered in idiopathic hyperprolactinemia and prolactinoma patients with a poor bromocriptine response